Healthcare Provider Details

I. General information

NPI: 1093123176
Provider Name (Legal Business Name): DINH LAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 N BROADWAY STE A
LOS ANGELES CA
90012-1764
US

IV. Provider business mailing address

510 N 13TH AVE STE 101
UPLAND CA
91786-4973
US

V. Phone/Fax

Practice location:
  • Phone: 213-625-7995
  • Fax:
Mailing address:
  • Phone: 909-985-8838
  • Fax: 909-985-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95026951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: