Provider Demographics
NPI:1881854826
Name:STANLEY LAU
Entity Type:Organization
Organization Name:STANLEY LAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-307-9822
Mailing Address - Street 1:1446 S SAN GABRIEL BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3656
Mailing Address - Country:US
Mailing Address - Phone:626-307-9822
Mailing Address - Fax:626-307-9222
Practice Address - Street 1:1446 S SAN GABRIEL BLVD
Practice Address - Street 2:STE A
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3656
Practice Address - Country:US
Practice Address - Phone:626-307-9822
Practice Address - Fax:626-307-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43148332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083774616OtherPLEASE UPDATE OUR NPI NO. FROM SOLE PROPRIETOR TO ORGANIZATION
CADME03159FMedicaid
CA1083774616OtherPLEASE UPDATE OUR NPI NO. FROM SOLE PROPRIETOR TO ORGANIZATION