Provider Demographics
NPI:1043296346
Name:LAI, ROBERT CHEN-SO (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHEN-SO
Last Name:LAI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 LEAFCREST WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2708
Mailing Address - Country:US
Mailing Address - Phone:916-442-2678
Mailing Address - Fax:
Practice Address - Street 1:10535 HOSPITAL WAY
Practice Address - Street 2:VANCHCS
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-1200
Practice Address - Country:US
Practice Address - Phone:916-843-7058
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE23460213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11298Medicare UPIN