Provider Demographics
NPI:1225041262
Name:LAU, ALEX KAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:KAM
Last Name:LAU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:1675 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-799-9088
Mailing Address - Fax:650-368-1370
Practice Address - Street 1:1675 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-799-9088
Practice Address - Fax:650-368-1370
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC7622171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0076220OtherBLUE SHIELD