Provider Demographics
NPI:1881914596
Name:LAU, DIANA WANYI
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:WANYI
Last Name:LAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WANYI
Other - Middle Name:DIANA
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2150 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6839
Mailing Address - Country:US
Mailing Address - Phone:323-726-0385
Mailing Address - Fax:
Practice Address - Street 1:2150 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6839
Practice Address - Country:US
Practice Address - Phone:323-726-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 40856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist