Provider Demographics
NPI:1558723205
Name:LAU, KEN (LAC)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 MCALLISTER ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4176
Mailing Address - Country:US
Mailing Address - Phone:650-383-7931
Mailing Address - Fax:
Practice Address - Street 1:2044 OLD MIDDLEFIELD WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2402
Practice Address - Country:US
Practice Address - Phone:650-965-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist