Provider Demographics
NPI:1013203520
Name:LAI, PHOEBE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:PHOEBE
Other - Middle Name:
Other - Last Name:LAI CHENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1414 FAIR OAKS AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:S PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-6218
Mailing Address - Country:US
Mailing Address - Phone:626-441-0899
Mailing Address - Fax:
Practice Address - Street 1:1414 FAIR OAKS AVE STE 9
Practice Address - Street 2:
Practice Address - City:S PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-6218
Practice Address - Country:US
Practice Address - Phone:626-441-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice