Provider Demographics
NPI:1326251364
Name:LAU, WEIHAUR RALPH
Entity Type:Individual
Prefix:MR
First Name:WEIHAUR
Middle Name:RALPH
Last Name:LAU
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RALPH
Other - Middle Name:WEIHAUR
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3715A MAYBELLE AVE,
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619
Mailing Address - Country:US
Mailing Address - Phone:415-652-1523
Mailing Address - Fax:
Practice Address - Street 1:2201 SUTTER ST.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94153
Practice Address - Country:US
Practice Address - Phone:415-541-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38BF3Medicaid