Provider Demographics
NPI:1952381410
Name:LAU, VICTOR KA TAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:KA TAI
Last Name:LAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 GOLF RD
Mailing Address - Street 2:SUITE 804
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-673-6770
Mailing Address - Fax:847-673-6778
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:SUITE 804
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-673-6770
Practice Address - Fax:847-673-6778
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025154332B00000X, 1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentist