Provider Demographics
NPI:1386901387
Name:LAU, MARCOS KWON YANG
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:KWON YANG
Last Name:LAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S ORANGE AVE APT F
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-7570
Mailing Address - Country:US
Mailing Address - Phone:626-324-8521
Mailing Address - Fax:
Practice Address - Street 1:431 S ORANGE AVE APT F
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-7570
Practice Address - Country:US
Practice Address - Phone:626-324-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program