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  5. LAC H. PHAM, M.D., P.A.

LAC H. PHAM, M.D., P.A.

Company Details

Entity Name: LAC H. PHAM, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 14 Mar 2000 (25 years ago)
Date of dissolution: 06 Mar 2023 (2 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 06 Mar 2023 (2 years ago)
Document Number: P00000026322
FEI/EIN Number 593634885
Address: 157 NORTH LAKEMONT AVENUE, WINTER PARK, FL, 32792
Mail Address: 157 NORTH LAKEMONT AVENUE, WINTER PARK, FL, 32792
ZIP code: 32792
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710148978 2008-06-20 2008-06-20 157 N LAKEMONT AVE, WINTER PARK, FL, 327923214, US 157 N LAKEMONT AVE, WINTER PARK, FL, 327923214, US

Contacts
Phone +1 407-644-6618
Fax 4076443755

Authorized person
Name DR. LAC H PHAM
Role DIRECTOR
Phone 4076446618

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number ME 34155
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 374598800
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAC H. PHAM M.D., P.A. PROFIT SHARING PLAN 2015 593634885 2016-04-18 LAC H. PHAM, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 4076446618
Plan sponsor’s address 157 N. LAKEMONT AVENUE, WINTER PARK, FL, 327923214

Signature of
Role Plan administrator
Date 2016-04-18
Name of individual signing LAC PHAM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-18
Name of individual signing LAC PHAM
Valid signature Filed with authorized/valid electronic signature
LAC H. PHAM M.D., P.A. PROFIT SHARING PLAN 2015 593634885 2016-11-04 LAC H. PHAM, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 4076446618
Plan sponsor’s address 157 N. LAKEMONT AVENUE, WINTER PARK, FL, 327923214
LAC H. PHAM M.D., P.A. PROFIT SHARING PLAN 2014 593634885 2015-06-04 LAC H. PHAM, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 4076446618
Plan sponsor’s address 157 N. LAKEMONT AVENUE, WINTER PARK, FL, 327923214

Signature of
Role Plan administrator
Date 2015-06-04
Name of individual signing LAC PHAM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-04
Name of individual signing LAC PHAM
Valid signature Filed with authorized/valid electronic signature
LAC H. PHAM M.D., P.A. PROFIT SHARING PLAN 2013 593634885 2014-06-25 LAC H. PHAM, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 4076446618
Plan sponsor’s address 157 N. LAKEMONT AVENUE, WINTER PARK, FL, 327923214

Signature of
Role Plan administrator
Date 2014-06-25
Name of individual signing LAC PHAM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-25
Name of individual signing LAC PHAM
Valid signature Filed with authorized/valid electronic signature
LAC H. PHAM M.D., P.A. PROFIT SHARING PLAN 2009 593634885 2010-07-09 LAC H. PHAM, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 4076446618
Plan sponsor’s address 157 N. LAKEMONT AVENUE, WINTER PARK, FL, 327923214

Plan administrator’s name and address
Administrator’s EIN 593634885
Plan administrator’s name LAC H. PHAM, M.D., P.A.
Plan administrator’s address 157 N. LAKEMONT AVENUE, WINTER PARK, FL, 327923214
Administrator’s telephone number 4076446618

Signature of
Role Plan administrator
Date 2010-07-08
Name of individual signing LAC H PHAM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-08
Name of individual signing LAC H PHAM
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PHAM LAC H Agent 157 NORTH LAKEMONT AVENUE, WINTER PARK, FL, 32792

Director

Name Role Address
PHAM LAC H Director 1057 HOWELL HARBOR ROAD, CASSELBERRY, FL, 32707

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2023-03-06 No data No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2023-03-06
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-03-16
ANNUAL REPORT 2020-02-12
ANNUAL REPORT 2019-03-06
ANNUAL REPORT 2018-02-16
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-01-28
ANNUAL REPORT 2015-01-19
ANNUAL REPORT 2014-01-10

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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