Healthcare Provider Details

I. General information

NPI: 1730150608
Provider Name (Legal Business Name): KHANG HUY LAI D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15701 ROCKFIELD BLVD
IRVINE CA
92618-2801
US

IV. Provider business mailing address

15701 ROCKFIELD BLVD
IRVINE CA
92618-2801
US

V. Phone/Fax

Practice location:
  • Phone: 949-457-9900
  • Fax: 949-457-9922
Mailing address:
  • Phone: 949-457-9900
  • Fax: 949-457-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A8226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: