Provider Demographics
NPI:1245332220
Name:LAI, GARY T (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:LAI
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:PO BOX 2703
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-2703
Mailing Address - Country:US
Mailing Address - Phone:909-548-3888
Mailing Address - Fax:909-548-3999
Practice Address - Street 1:14335 PIPELINE AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5642
Practice Address - Country:US
Practice Address - Phone:909-548-3888
Practice Address - Fax:909-548-3999
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A650300Medicaid
H06902Medicare UPIN
CA00A650300Medicaid