Provider Demographics
NPI:1396930038
Name:JASON S. LAI, M.D.,INC
Entity type:Organization
Organization Name:JASON S. LAI, M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SHUNG
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-907-7600
Mailing Address - Street 1:14350 WHITTIER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2122
Mailing Address - Country:US
Mailing Address - Phone:562-907-7600
Mailing Address - Fax:562-907-7602
Practice Address - Street 1:14350 WHITTIER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2122
Practice Address - Country:US
Practice Address - Phone:562-907-7600
Practice Address - Fax:562-907-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86130261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86130OtherLICENSE
CAA86130OtherLICENSE
CAW21103OtherMEDICARE PTAN