Provider Demographics
NPI:1467433144
Name:LAU, KRISTIN K (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:K
Last Name:LAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:K
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20940 N TATUM BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7273
Mailing Address - Country:US
Mailing Address - Phone:480-407-0060
Mailing Address - Fax:480-607-5809
Practice Address - Street 1:20940 N TATUM BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7273
Practice Address - Country:US
Practice Address - Phone:480-407-0060
Practice Address - Fax:480-607-5809
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860933Medicaid
AZI08381Medicare UPIN
AZZ81600Medicare PIN