Provider Demographics
NPI:1942526686
Name:LAI, JEFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3655 LOMITA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-1910
Mailing Address - Country:US
Mailing Address - Phone:424-363-7488
Mailing Address - Fax:424-363-7499
Practice Address - Street 1:3655 LOMITA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1910
Practice Address - Country:US
Practice Address - Phone:424-363-7488
Practice Address - Fax:424-363-7499
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2020-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA113395207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGH652ZMedicare PIN