Healthcare Provider Details

I. General information

NPI: 1588553325
Provider Name (Legal Business Name): POCHING LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 TALBERT AVE STE 101
FOUNTAIN VALLEY CA
92708-5153
US

IV. Provider business mailing address

9940 TALBERT AVE STE 101
FOUNTAIN VALLEY CA
92708-5153
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-8700
  • Fax: 714-545-8084
Mailing address:
  • Phone: 714-545-8700
  • Fax: 714-545-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: