Provider Demographics
NPI:1750664355
Name:WALTER LAM DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WALTER LAM DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-1020
Mailing Address - Street 1:723 S GARFIELD AVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4429
Mailing Address - Country:US
Mailing Address - Phone:626-289-1020
Mailing Address - Fax:626-768-7334
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3195
Practice Address - Country:US
Practice Address - Phone:626-679-7977
Practice Address - Fax:626-768-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment