Provider Demographics
NPI:1437172467
Name:SEAN CHEONG F LAI
Entity Type:Organization
Organization Name:SEAN CHEONG F LAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:CHEONG
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-453-0553
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:1286W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-453-0553
Mailing Address - Fax:310-829-3400
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:1286W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-0553
Practice Address - Fax:310-829-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40912207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098070Medicaid
CAZZZ65413ZOtherBLUE SHIELD OF CALIFORNIA
CAW12216Medicare ID - Type Unspecified