Provider Demographics
NPI:1548202740
Name:LAI, ANNIE PO WAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:PO WAH
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CRANE ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4260
Mailing Address - Country:US
Mailing Address - Phone:650-498-6530
Mailing Address - Fax:
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA647592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A6475914Medicare PIN
CA00A647592Medicare PIN
CA00A6475922Medicare PIN
CA00A647597Medicare PIN
CA00A647598Medicare PIN
CA00A647594Medicare PIN
CA00A6475910Medicare PIN
CA00A6475921Medicare PIN
CA00A647596Medicare PIN
CA00A6475915Medicare PIN
CA00A6475918Medicare PIN
CA300137312Medicare PIN
CA00A6475913Medicare PIN
CA00A6475916Medicare PIN
CA00A6475917Medicare PIN
CA00A647599Medicare PIN
CA00A6475912Medicare PIN
CA00A6475919Medicare PIN
CA00A647593Medicare PIN
CA300137315Medicare PIN
CA300137311Medicare PIN
CAH53714Medicare UPIN
CA00A6475920Medicare PIN
CA00A647595Medicare PIN
CA00A6475911Medicare PIN