Healthcare Provider Details

I. General information

NPI: 1487078002
Provider Name (Legal Business Name): PARNTIP LAI AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PARNTIP CHERTBOONMUANG

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLZ STE 630
LOS ANGELES CA
90024-6997
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95000122
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number95000122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: