Provider Demographics
NPI:1841069424
Name:LAI, KALEB CAN
Entity type:Individual
Prefix:
First Name:KALEB
Middle Name:CAN
Last Name:LAI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 S DEEGAN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6611
Mailing Address - Country:US
Mailing Address - Phone:714-837-3087
Mailing Address - Fax:
Practice Address - Street 1:160 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4401
Practice Address - Country:US
Practice Address - Phone:951-674-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist