Provider Demographics
NPI:1437403557
Name:LAI, LINGWEN KEVIN
Entity Type:Individual
Prefix:
First Name:LINGWEN
Middle Name:KEVIN
Last Name:LAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 COLLEYVILLE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8007
Mailing Address - Country:US
Mailing Address - Phone:817-600-2391
Mailing Address - Fax:
Practice Address - Street 1:7155 COLLEYVILLE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8007
Practice Address - Country:US
Practice Address - Phone:817-600-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
TXAC01329171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist