Provider Demographics
NPI:1790949535
Name:LA, MIKE QUOC CHAU (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:QUOC CHAU
Last Name:LA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1250 16TH ST
Mailing Address - Street 2:SUITE 2304
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1249
Mailing Address - Country:US
Mailing Address - Phone:310-319-4698
Mailing Address - Fax:310-319-4908
Practice Address - Street 1:1250 16TH ST
Practice Address - Street 2:SUITE 2304
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1249
Practice Address - Country:US
Practice Address - Phone:310-319-4698
Practice Address - Fax:310-319-4908
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2017-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA112861207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790949535Medicaid
CAGM097ZMedicare PIN