Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E23460 | CA |
Y | 222Z00000X | Podiatrist | E23460 | CA |
NPI | 1043296346 |
---|---|
Provider Name | Dr. Robert Chen-So Lai |
First Address | Fair Oaks, CA 95628-2708 |
Second Address | Mather, CA 95655-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11298 | (02) | CA |