Basic Information
| Provider Information | |||||||||
| NPI: | 1437346814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | GIA | ||||||||
| MiddleName: | THANH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1841 | ||||||||
| Address2: | CALIFORNIA REHABILITATION CENTER CRC | ||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928600991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517372683 | ||||||||
| FaxNumber: | 9512732318 | ||||||||
| Practice Location | |||||||||
| Address1: | 5TH & WESTERN ST | ||||||||
| Address2: | CALIFORNIA REHABILITATION CENTER CRC | ||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928600991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517372683 | ||||||||
| FaxNumber: | 9512732318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2007 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A39556 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.