Provider Demographics
NPI:1780670240
Name:LAU, KIRKLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRKLAND
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ORCHARD VIEW RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2208 QUARRY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609-1158
Practice Address - Country:US
Practice Address - Phone:610-685-2449
Practice Address - Fax:610-685-2401
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012763207N00000X, 207Q00000X
CT048389207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00968153OtherRAILROAD
PA1743088OtherBLUE SHIELD
087779NZEMedicare ID - Type Unspecified
TXP00968153OtherRAILROAD
PAI24631Medicare UPIN