Provider Demographics
NPI:1548222813
Name:LAU, STANLEY KWONG (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:KWONG
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3731
Mailing Address - Country:US
Mailing Address - Phone:626-308-3800
Mailing Address - Fax:626-308-1899
Practice Address - Street 1:506 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3731
Practice Address - Country:US
Practice Address - Phone:626-308-3800
Practice Address - Fax:626-308-1899
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46648207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10959167OtherCAQH #
CARHD136312OtherFLURO/X-RAY SUPERVISOR
CA00A466480OtherBLUE SHIELD OF CA
CA00A466480Medicaid
CA10959167OtherCAQH #
CAWA46648CMedicare PIN