1972731701 NPI number — DR. JULIE LAM O.D.

Table of content: DR. JULIE LAM O.D. (NPI 1972731701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972731701 NPI number — DR. JULIE LAM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAM
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972731701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29605 N CAVE CREEK RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-361-7040
Provider Business Mailing Address Fax Number:
480-361-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29605 N CAVE CREEK RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85331-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-361-7040
Provider Business Practice Location Address Fax Number:
480-361-5223
Provider Enumeration Date:
07/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1694 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z134584 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".