Provider Demographics
NPI:1114271061
Name:RICHARD KY LAU JR MD INC
Entity Type:Organization
Organization Name:RICHARD KY LAU JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KY
Authorized Official - Last Name:LAU
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:808-955-3636
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-955-3636
Mailing Address - Fax:808-943-2777
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 608
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-955-3636
Practice Address - Fax:808-943-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02655301Medicaid
HI00D0029696OtherHMSA
HI02655301Medicaid