Provider Demographics
NPI:1275606261
Name:LAU, ERIC B (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:B
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 1:3833 WORSHAM AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1745
Mailing Address - Country:US
Mailing Address - Phone:562-595-5479
Mailing Address - Fax:562-988-7616
Practice Address - Street 1:3833 WORSHAM AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1745
Practice Address - Country:US
Practice Address - Phone:562-595-5479
Practice Address - Fax:562-988-7616
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA70371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703710Medicaid