Provider Demographics
NPI:1902829781
Name:LAU, SERENA SUN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:SUN
Last Name:LAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 MONTEREY ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5117
Mailing Address - Country:US
Mailing Address - Phone:408-778-0866
Mailing Address - Fax:
Practice Address - Street 1:16430 MONTEREY ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5117
Practice Address - Country:US
Practice Address - Phone:408-778-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8594171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist