Provider Demographics
NPI:1245865864
Name:LAU, BRANDON KAM SHIN (PA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:KAM SHIN
Last Name:LAU
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:281 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2056
Mailing Address - Country:US
Mailing Address - Phone:646-596-7386
Mailing Address - Fax:646-850-9326
Practice Address - Street 1:281 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2056
Practice Address - Country:US
Practice Address - Phone:646-596-7386
Practice Address - Fax:646-850-9326
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2022-01-13
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Provider Licenses
StateLicense IDTaxonomies
NY024792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant