Provider Demographics
NPI:1093797557
Name:LAI, DONALD MANG-SUM (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MANG-SUM
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 1:5565 W LAS POSITAS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5805
Mailing Address - Country:US
Mailing Address - Phone:925-534-6880
Mailing Address - Fax:
Practice Address - Street 1:5565 W LAS POSITAS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5805
Practice Address - Country:US
Practice Address - Phone:925-534-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54833207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G548330Medicaid
CA00G548330Medicaid
CA00G548330Medicare ID - Type Unspecified