Provider Demographics
NPI:1891824777
Name:LAI, EDWIN J (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:J
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1135 116TH AVE NE STE 560
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 560
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-454-4768
Practice Address - Fax:425-462-8021
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00047860207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8490229Medicaid
H94115Medicare UPIN