Individual
JOHNNY LUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1389 W MAIN ST, WATERBURY, CT 06708-3104
(203) 755-5555
(203) 573-8523
Mailing address
4 UNION AVE APT 20, NORWALK, CT 06851-3735
(203) 919-4635
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000669
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004085636
—
CT
Enumeration date
05/04/2006
Last updated
03/19/2026
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