Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 64816 | CA |
NPI | 1003292145 |
---|---|
Provider Name | Vickie Lai |
First Address | Arcadia, CA 91007-4021 |
Second Address | Burbank, CA 91505-4050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 30/07/2015 |