Provider Demographics
NPI:1245427350
Name:LAU, DANIEL ING PAK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ING PAK
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 1:12555 W JEFFERSON BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7032
Mailing Address - Country:US
Mailing Address - Phone:424-443-5600
Mailing Address - Fax:424-443-5606
Practice Address - Street 1:12555 W JEFFERSON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7032
Practice Address - Country:US
Practice Address - Phone:424-443-5600
Practice Address - Fax:424-443-5606
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95242208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics