Provider Demographics
NPI:1275617094
Name:LAU, KWOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KWOK
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 19TH AVE
Mailing Address - Street 2:#3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3169
Mailing Address - Country:US
Mailing Address - Phone:415-752-3903
Mailing Address - Fax:
Practice Address - Street 1:1291 E HILLSDALE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1220
Practice Address - Country:US
Practice Address - Phone:650-522-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice