Provider Demographics
NPI:1265599336
Name:LAI, MINGCHUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:MINGCHUNG
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:700 N DIAMOND BAR BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1060
Mailing Address - Country:US
Mailing Address - Phone:909-860-7780
Mailing Address - Fax:
Practice Address - Street 1:700 N DIAMOND BAR BLVD
Practice Address - Street 2:STE C
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1060
Practice Address - Country:US
Practice Address - Phone:909-860-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice