Provider Demographics
NPI:1891954772
Name:LUM, BRENT LEONG (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LEONG
Last Name:LUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3650 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3439
Mailing Address - Country:US
Mailing Address - Phone:510-886-2503
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-476-3484
Practice Address - Fax:209-476-3012
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP1-0032047207W00000X
CAA116550207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology