Provider Demographics
NPI:1518930197
Name:LAM, PHUC THOAI (MD)
Entity Type:Individual
Prefix:DR
First Name:PHUC
Middle Name:THOAI
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:THOAI
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:467 ARCADIA WAY
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-2178
Mailing Address - Country:US
Mailing Address - Phone:714-209-8319
Mailing Address - Fax:831-444-6447
Practice Address - Street 1:10872 WESTMINSTER AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4981
Practice Address - Country:US
Practice Address - Phone:714-209-8319
Practice Address - Fax:714-530-2365
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 88219207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88219Medicare PIN
I 19228Medicare UPIN