Provider Demographics
NPI:1730563107
Name:LAU, JEAN KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:KIM
Last Name:LAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2571 BAGLYOS CIR STE B23
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8051
Mailing Address - Country:US
Mailing Address - Phone:484-821-1357
Mailing Address - Fax:
Practice Address - Street 1:2571 BAGLYOS CIR STE B23
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8051
Practice Address - Country:US
Practice Address - Phone:484-821-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2023-03-28
Deactivation Date:2019-08-01
Deactivation Code:
Reactivation Date:2019-09-05
Provider Licenses
StateLicense IDTaxonomies
PADS0422631223S0112X
NY0604861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty