Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A142174 | CA |
N | 111NI0900X | Internist | A142174 | CA |
N | 207RG0300X | Geriatric Medicine | 288718 | NY |
N | 207RG0300X | Geriatric Medicine | A142174 | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | A142174 | CA |
NPI | 1346669207 |
---|---|
Provider Name | Dr. Samantha Fong-Ting Lau |
First Address | Newport Beach, CA 92659-8589 |
Second Address | Newport Beach, CA 92663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05535653 | (05) | NY |