Provider Demographics
NPI:1932495041
Name:LAU, CHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
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 1:201 S LASKY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3610
Mailing Address - Country:US
Mailing Address - Phone:310-277-4572
Mailing Address - Fax:310-556-1088
Practice Address - Street 1:201 S LASKY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3610
Practice Address - Country:US
Practice Address - Phone:310-277-4572
Practice Address - Fax:310-556-1088
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116091207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery