Provider Demographics
NPI:1437141967
Name:LAI, CHI KWONG (MD)
Entity Type:Individual
Prefix:
First Name:CHI
Middle Name:KWONG
Last Name:LAI
Suffix:
Gender:M
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 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-778-8513
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:351 NE FRANKLIN ST
Practice Address - Street 2:STE 1
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3089
Practice Address - Country:US
Practice Address - Phone:386-292-8250
Practice Address - Fax:386-292-7722
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23589207RC0000X
FLME129713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950610Medicaid
NC202190DMedicare PIN
NC202190FMedicare PIN
NC8950610Medicaid
060035918Medicare PIN