Provider Demographics
NPI:1629056320
Name:LAU, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-537-1974
Mailing Address - Fax:808-537-1976
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-537-1974
Practice Address - Fax:808-537-1976
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2013-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD3795208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04790401Medicaid
HIN54527OtherHMSA
D36165Medicare UPIN
HI04790401Medicaid