1851333918 NPI number — MICHAEL CHI-KIN LAI M.D.

Table of content: MICHAEL CHI-KIN LAI M.D. (NPI 1851333918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851333918 NPI number — MICHAEL CHI-KIN LAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAI
Provider First Name:
MICHAEL
Provider Middle Name:
CHI-KIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1851333918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94948-6102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-884-3418
Provider Business Mailing Address Fax Number:
415-883-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 SULLIVAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-991-6503
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

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: 2085R0202X , with the licence number:  A68834 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5578LA . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8464539 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A688340 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0213298 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00142641 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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