Provider Demographics
NPI:1003012402
Name:CHITTAPHONG, LAM (DDS)
Entity type:Individual
Prefix:DR
First Name:LAM
Middle Name:
Last Name:CHITTAPHONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9888 CARROLL CENTRE RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4579
Mailing Address - Country:US
Mailing Address - Phone:858-722-6332
Mailing Address - Fax:888-514-1239
Practice Address - Street 1:9888 CARROLL CENTRE RD
Practice Address - Street 2:SUITE #120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4579
Practice Address - Country:US
Practice Address - Phone:858-722-6332
Practice Address - Fax:888-514-1239
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics