Provider Demographics
NPI:1295094324
Name:LAI, TIM TIEN (MD)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:TIEN
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIEN
Other - Middle Name:THANG
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:STE 152
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7510
Mailing Address - Country:US
Mailing Address - Phone:714-486-2521
Mailing Address - Fax:714-486-2613
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:STE 152
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7510
Practice Address - Country:US
Practice Address - Phone:714-486-2521
Practice Address - Fax:714-486-2613
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1283802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology