Provider Demographics
NPI:1326031030
Name:LAU, ANNIE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:Y
Last Name:LAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660877
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95866-0877
Mailing Address - Country:US
Mailing Address - Phone:916-481-6800
Mailing Address - Fax:916-481-1881
Practice Address - Street 1:1200 B GALE WILSON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3552
Practice Address - Country:US
Practice Address - Phone:916-481-6800
Practice Address - Fax:916-481-1881
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38392207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A383920Medicaid
CA00A383921Medicare PIN