Provider Demographics
NPI:1124041173
Name:LAI, S PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:PATRICK
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 1:1110 E MAIN ST
Mailing Address - Street 2:# 101
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-284-5252
Mailing Address - Fax:626-284-5256
Practice Address - Street 1:1110 E MAIN ST
Practice Address - Street 2:# 101
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-284-5252
Practice Address - Fax:626-284-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2137213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE21372Medicaid
CA480003517OtherRAILROAD MEDICARE
4684520001Medicare NSC
CA480003517OtherRAILROAD MEDICARE
CAGC002ZMedicare PIN
CAE2137AMedicare ID - Type Unspecified