Provider Demographics
NPI:1396739470
Name:LAI, SEAN C (MD,)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:C
Last Name:LAI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 1286W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-453-0553
Mailing Address - Fax:310-943-2776
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 1286W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-0553
Practice Address - Fax:310-943-2776
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2015-06-17
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40912Medicaid
CAG40912Medicaid
CAW12216Medicare ID - Type Unspecified