Provider Demographics
NPI:1912968868
Name:LAI, KIN MAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIN MAN
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIN-MAN
Other - Middle Name:
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2 BON AIR RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-927-0666
Mailing Address - Fax:415-927-6178
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:SUITE #100
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-927-0666
Practice Address - Fax:415-927-6178
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA636512086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636510Medicaid
G60779Medicare UPIN
CA00A636510Medicaid