1912988890 NPI number — MARK C LAU MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	LAU
Provider First Name	:	MARK
Provider Middle Name	:	C
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Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

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NPI Number	:	1912988890
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	PEDIATRIC CLINIC
Provider Second Line Business Mailing Address	:	UNITED STATES ARMY HEALTH CLINIC BUILDING 680
Provider Business Mailing Address City Name	:	SCHOFIELD BARRACKS
Provider Business Mailing Address State Name	:	HI
Provider Business Mailing Address Postal Code	:	968575460
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8084338175
Provider Business Mailing Address Fax Number	:	8084338407

Provider First Line Business Practice Location Address	:	PEDIATRIC CLINIC
Provider Second Line Business Practice Location Address	:	UNITED STATES ARMY HEALTH CLINIC BUILDING 680
Provider Business Practice Location Address City Name	:	SCHOFIELD BARRACKS
Provider Business Practice Location Address State Name	:	HI
Provider Business Practice Location Address Postal Code	:	968575460
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	8084338175
Provider Business Practice Location Address Fax Number	:	8084338407
Provider Enumeration Date	:	11/08/2005

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• Taxonomy code: 207R00000X , with the licence number:  12613 , registered in the state of HI .
• Taxonomy code: 208000000X , with the licence number: 12613 , registered in the state of HI .

• Identifier: VAD000 . This identifiers is of the category "".