Provider Demographics
NPI:1750482428
Name:DORMAN, LAI LE
Entity Type:Individual
Prefix:MRS
First Name:LAI
Middle Name:LE
Last Name:DORMAN
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 1:41 SHEARWATER PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2910
Mailing Address - Country:US
Mailing Address - Phone:714-480-6680
Mailing Address - Fax:714-568-4362
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3640
Practice Address - Country:US
Practice Address - Phone:714-480-6680
Practice Address - Fax:714-568-4362
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health