Provider Demographics
NPI:1992860829
Name:CHAN, LISA LAI (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LAI
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12609 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5136
Mailing Address - Country:US
Mailing Address - Phone:281-655-5100
Mailing Address - Fax:281-655-1415
Practice Address - Street 1:12609 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5136
Practice Address - Country:US
Practice Address - Phone:281-655-5100
Practice Address - Fax:281-655-1415
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048021202Medicaid
TXG80561Medicare UPIN
TX048021202Medicaid