Provider Demographics
NPI:1639451339
Name:LAI, HEUNG PAN
Entity Type:Individual
Prefix:MS
First Name:HEUNG
Middle Name:PAN
Last Name:LAI
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 1:199 PARNASSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4260
Mailing Address - Country:US
Mailing Address - Phone:415-661-5287
Mailing Address - Fax:415-661-7519
Practice Address - Street 1:199 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4260
Practice Address - Country:US
Practice Address - Phone:415-661-5287
Practice Address - Fax:415-661-7519
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist