Provider Demographics
NPI:1306874532
Name:LAI, LAURA T (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:T
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W CALIFORNIA BLVD
Mailing Address - Street 2:# 297
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3005
Mailing Address - Country:US
Mailing Address - Phone:626-963-4467
Mailing Address - Fax:
Practice Address - Street 1:115 W CALIFORNIA BLVD
Practice Address - Street 2:# 297
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3005
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA662982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A662980Medicaid
CA00A662980Medicaid