Provider Demographics
NPI:1346746930
Name:BANKS-DEAN, LAKAI MONEE (MD)
Entity type:Individual
Prefix:
First Name:LAKAI
Middle Name:MONEE
Last Name:BANKS-DEAN
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 1:280 E STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:92415-4414
Mailing Address - Country:US
Mailing Address - Phone:707-466-0002
Mailing Address - Fax:
Practice Address - Street 1:280 E STANLEY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4414
Practice Address - Country:US
Practice Address - Phone:707-466-0002
Practice Address - Fax:707-466-0001
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167046207Q00000X
CAA176046207Q00000X, 207QA0401X
CAA167046207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine