Provider Demographics
NPI:1588228696
Name:LAU, KYNA
Entity Type:Individual
Prefix:
First Name:KYNA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 RIO SAN DIEGO DR APT 5203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5693
Mailing Address - Country:US
Mailing Address - Phone:614-218-8105
Mailing Address - Fax:
Practice Address - Street 1:6985 EL CAMINO REAL STE A103
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4148
Practice Address - Country:US
Practice Address - Phone:760-444-3800
Practice Address - Fax:760-444-3811
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist