Provider Demographics
NPI:1609837384
Name:LUM, WAIHO (MD)
Entity Type:Individual
Prefix:
First Name:WAIHO
Middle Name:
Last Name:LUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5633
Mailing Address - Country:US
Mailing Address - Phone:718-268-6808
Mailing Address - Fax:718-268-6858
Practice Address - Street 1:11201 75TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5633
Practice Address - Country:US
Practice Address - Phone:718-268-6808
Practice Address - Fax:718-268-6858
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202905207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG74127Medicare UPIN