Provider Demographics
NPI:1902069669
Name:LAI, JENNIFER CHIA FANG (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHIA FANG
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4951 ARROYO RD
Mailing Address - Street 2:BLDG 62, RM 458
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-9650
Mailing Address - Country:US
Mailing Address - Phone:925-373-5579
Mailing Address - Fax:925-449-6477
Practice Address - Street 1:4951 ARROYO RD
Practice Address - Street 2:BLDG 62, RM 458
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9650
Practice Address - Country:US
Practice Address - Phone:925-373-5579
Practice Address - Fax:925-449-6477
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA105715207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program