Provider Demographics
NPI:1720263734
Name:LAU, KAYAO (NP)
Entity Type:Individual
Prefix:MS
First Name:KAYAO
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYAO
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-724-4000
Mailing Address - Fax:617-724-9994
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-4000
Practice Address - Fax:617-724-9994
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273320363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health