Provider Demographics
NPI:1427055862
Name:LAU, JOHN SENG UNG (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SENG UNG
Last Name:LAU
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 1:784 E PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2271
Mailing Address - Country:US
Mailing Address - Phone:772-878-7311
Mailing Address - Fax:772-878-7321
Practice Address - Street 1:784 E PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2271
Practice Address - Country:US
Practice Address - Phone:772-878-7311
Practice Address - Fax:772-878-7321
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00744013OtherRR MEDICARE
FL270440400Medicaid
FLI16191Medicare UPIN
FL270440400Medicaid
FL48200YMedicare PIN