Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01044085A | IN |
Y | 208600000X | Surgeon | 01044085A | IN |
NPI | 1023087673 |
---|---|
Provider Name | Khoa D Lai |
First Address | Lafayette, IN 47903-4699 |
Second Address | Lafayette, IN 47905-5762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200050500 | (05) | IN |
G10119 | (02) | IN |