Provider Demographics
NPI:1235312216
Name:CHRISTOPHER C LAI MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTOPHER C LAI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-344-9093
Mailing Address - Street 1:196 W LEGION RD
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-7713
Mailing Address - Country:US
Mailing Address - Phone:760-344-9093
Mailing Address - Fax:760-344-4309
Practice Address - Street 1:196 W LEGION RD
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7713
Practice Address - Country:US
Practice Address - Phone:760-344-9093
Practice Address - Fax:760-344-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667010Medicaid
CA00A667010Medicaid
WA66701AMedicare PIN