Provider Demographics
NPI:1629603659
Name:LAI, LINH (RDO)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STORY RD STE 1079
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2670
Mailing Address - Country:US
Mailing Address - Phone:408-288-5037
Mailing Address - Fax:408-288-9265
Practice Address - Street 1:1111 STORY RD STE 1079
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2670
Practice Address - Country:US
Practice Address - Phone:408-288-5037
Practice Address - Fax:408-288-9265
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL5355156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician