Provider Demographics
NPI:1710038229
Name:LAI, MICHAEL MING LONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MING LONG
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:19734 LULL ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2675
Mailing Address - Country:US
Mailing Address - Phone:310-709-1360
Mailing Address - Fax:
Practice Address - Street 1:11398 KENYON WAY
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9229
Practice Address - Country:US
Practice Address - Phone:909-477-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA91703207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology