Provider Demographics
NPI:1851333918
Name:LAI, MICHAEL CHI-KIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHI-KIN
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:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:415-883-8082
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:650-991-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA688342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5578LAOtherREGENCE BLUE SHIELD
WA8464539Medicaid
CA00A688340Medicaid
WA0213298OtherL&I
CAP00142641OtherRAILROAD MEDICARE
CADZ997YMedicare PIN
CA00A688348Medicare PIN
CAP00142641OtherRAILROAD MEDICARE
WA8464539Medicaid
CA00A6883410Medicare PIN
CA00A6883411Medicare PIN
CA00A688349Medicare PIN