Provider Demographics
NPI:1265503965
Name:LAI, JASON SHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SHUNG
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14350 WHITTIER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2122
Mailing Address - Country:US
Mailing Address - Phone:562-907-7600
Mailing Address - Fax:562-907-7602
Practice Address - Street 1:14350 WHITTIER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2122
Practice Address - Country:US
Practice Address - Phone:562-907-7600
Practice Address - Fax:562-907-7602
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86130208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86130OtherMED LIC
CAWA86130AOtherMEDICARE PTAN
CAI15284Medicare UPIN