Provider Demographics
NPI:1144211665
Name:LAU, BENJAMIN CK (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CK
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4306 GEARY BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3059
Mailing Address - Country:US
Mailing Address - Phone:415-876-6400
Mailing Address - Fax:415-876-6402
Practice Address - Street 1:4306 GEARY BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3059
Practice Address - Country:US
Practice Address - Phone:415-876-6400
Practice Address - Fax:415-876-6402
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60654208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606540Medicaid
CAG85794Medicare UPIN