Basic Information
| Provider Information | |||||||||
| NPI: | 1568895175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUM | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 GAGE BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993529532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423125 | ||||||||
| FaxNumber: | 5095858173 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 S ZINTEL WAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993375092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423125 | ||||||||
| FaxNumber: | 5095858173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2013 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60966705 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.