Provider Demographics
NPI:1942597554
Name:CHAU, DIEM-MAI NGUYEN-LAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIEM-MAI
Middle Name:NGUYEN-LAM
Last Name:CHAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIEM-MAI
Other - Middle Name:NGUYEN
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5363 BALBOA BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2830
Mailing Address - Country:US
Mailing Address - Phone:714-600-7317
Mailing Address - Fax:
Practice Address - Street 1:5363 BALBOA BLVD STE 328
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2830
Practice Address - Country:US
Practice Address - Phone:818-784-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice