Provider Demographics
NPI:1225828866
Name:LAI, LACEY MAE (PA-C)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:MAE
Last Name:LAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 W STEPHENS VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8421
Mailing Address - Country:US
Mailing Address - Phone:714-595-2008
Mailing Address - Fax:
Practice Address - Street 1:308 E 4500 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4057
Practice Address - Country:US
Practice Address - Phone:385-533-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14215824-1206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology