Healthcare Provider Details

I. General information

NPI: 1033795851
Provider Name (Legal Business Name): KRYSTAL YA-FONG LAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 LE CONTE AVE
LOS ANGELES CA
90095-6949
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-0449
  • Fax:
Mailing address:
  • Phone: 310-206-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV0010
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberV0010
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA209269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: