Provider Demographics
NPI:1194882332
Name:RICHARD C. LAM, M.D., INC.
Entity type:Organization
Organization Name:RICHARD C. LAM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CAO
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-679-6467
Mailing Address - Street 1:27994 BRADLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2240
Mailing Address - Country:US
Mailing Address - Phone:951-679-6467
Mailing Address - Fax:951-679-1500
Practice Address - Street 1:27994 BRADLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2240
Practice Address - Country:US
Practice Address - Phone:951-679-6467
Practice Address - Fax:951-679-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A65420OtherBLUESHIELD
CAZZZ62690ZOtherBLUESHIELD
CA00A615420Medicaid
CA11003500OtherCAQH
CA11003500OtherCAQH
CAG68070Medicare UPIN
CAZZZ29752ZMedicare ID - Type Unspecified
CA00A615420Medicare ID - Type Unspecified