Healthcare Provider Details

I. General information

NPI: 1407819170
Provider Name (Legal Business Name): ROGER CHIH-HUNG LAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

PO BOX 80116
CITY OF INDUSTRY CA
91716-8116
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax: 405-751-3183
Mailing address:
  • Phone: 800-749-4560
  • Fax: 405-751-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA71765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: