Provider Demographics
NPI:1265661177
Name:LAI, JASMINE (MD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:LAI
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 1:9333 GENESEE AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2138
Mailing Address - Country:US
Mailing Address - Phone:858-626-6261
Mailing Address - Fax:
Practice Address - Street 1:9333 GENESEE AVE STE 170
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-626-6261
Practice Address - Fax:858-626-6271
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113482207V00000X, 207VM0101X
WAMD60341945207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1265661177Medicaid
WA1265661177Medicaid