Healthcare Provider Details

I. General information

NPI: 1033110671
Provider Name (Legal Business Name): YEN INGRID LAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N INDIAN HILL BLVD # 240
CLAREMONT CA
91711-4611
US

IV. Provider business mailing address

310 N INDIAN HILL BLVD # 240
CLAREMONT CA
91711-4611
US

V. Phone/Fax

Practice location:
  • Phone: 909-244-8902
  • Fax: 714-482-4000
Mailing address:
  • Phone: 909-244-8902
  • Fax: 714-482-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: