Healthcare Provider Details

I. General information

NPI: 1699303172
Provider Name (Legal Business Name): AARON-JAMES LAO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 375A
BURBANK CA
91505-4558
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 375A
BURBANK CA
91505-4558
US

V. Phone/Fax

Practice location:
  • Phone: 818-729-0014
  • Fax: 818-729-0019
Mailing address:
  • Phone: 818-729-0014
  • Fax: 818-729-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: