Provider Demographics
NPI:1902498157
Name:LAI, MASON (LE)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:LE
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:AURORA
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LE
Mailing Address - Street 1:41 S CHESTER AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3104
Mailing Address - Country:US
Mailing Address - Phone:626-460-0048
Mailing Address - Fax:
Practice Address - Street 1:1041 E GREEN ST STE 207
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2417
Practice Address - Country:US
Practice Address - Phone:626-460-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9669374700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty