Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7161 | IN |
NPI | 1013002310 |
---|---|
Provider Name | Dr. Kenneth U Lau |
First Address | Pendleton, IN 46064 |
Second Address | Pendleton, IN 46064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 11/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000019629 | ANTHEM (01) | |
351702814001 | (02) |