1952381410 NPI number — DR. VICTOR KA TAI LAU DDS

Table of content: DR. VICTOR KA TAI LAU DDS (NPI 1952381410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952381410 NPI number — DR. VICTOR KA TAI LAU DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAU
Provider First Name:
VICTOR
Provider Middle Name:
KA TAI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952381410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4709 GOLF RD
Provider Second Line Business Mailing Address:
SUITE 804
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-673-6770
Provider Business Mailing Address Fax Number:
847-673-6778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4709 GOLF RD
Provider Second Line Business Practice Location Address:
SUITE 804
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-673-6770
Provider Business Practice Location Address Fax Number:
847-673-6778
Provider Enumeration Date:
01/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  019025154 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 019025154 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 019025154 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)