Provider Demographics
NPI:1508477852
Name:LAI, KHANG (KHANG)
Entity Type:Individual
Prefix:MR
First Name:KHANG
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:KHANG
Other - Prefix:MR
Other - First Name:KHANG
Other - Middle Name:
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:9681 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2911
Mailing Address - Country:US
Mailing Address - Phone:714-837-9120
Mailing Address - Fax:
Practice Address - Street 1:9681 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2911
Practice Address - Country:US
Practice Address - Phone:714-837-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist