Provider Demographics
NPI:1609920180
Name:LAI, CHENYU III (DDS)
Entity Type:Individual
Prefix:
First Name:CHENYU
Middle Name:
Last Name:LAI
Suffix:III
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 S DIAMOND BAR BLVD
Mailing Address - Street 2:#G
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4149
Mailing Address - Country:US
Mailing Address - Phone:909-396-8111
Mailing Address - Fax:909-396-8801
Practice Address - Street 1:1345 S DIAMOND BAR BLVD
Practice Address - Street 2:#G
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4149
Practice Address - Country:US
Practice Address - Phone:909-396-8111
Practice Address - Fax:909-396-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice