Provider Demographics
NPI:1033110671
Name:LAI, YEN INGRID (MD)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:INGRID
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N INDIAN HILL BLVD # 240
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4611
Mailing Address - Country:US
Mailing Address - Phone:909-244-8902
Mailing Address - Fax:714-482-4000
Practice Address - Street 1:310 N INDIAN HILL BLVD # 240
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4611
Practice Address - Country:US
Practice Address - Phone:909-244-8902
Practice Address - Fax:714-482-4000
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BL5661562OtherDEA #
BL5661562OtherDEA #