Provider Demographics
NPI:1720013675
Name:LAI, HUNG DAT (DC)
Entity Type:Individual
Prefix:DR
First Name:HUNG
Middle Name:DAT
Last Name:LAI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 VALLEY VIEW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670
Mailing Address - Country:US
Mailing Address - Phone:562-600-0218
Mailing Address - Fax:323-287-8783
Practice Address - Street 1:14311 VALLEY VIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:562-600-0218
Practice Address - Fax:323-287-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV06480Medicare UPIN