Healthcare Provider Details

I. General information

NPI: 1730626854
Provider Name (Legal Business Name): JOSEPH LAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LANKERSHIM BLVD FL 9
NORTH HOLLYWOOD CA
91601-3186
US

IV. Provider business mailing address

5250 LANKERSHIM BLVD FL 9
NORTH HOLLYWOOD CA
91601-3186
US

V. Phone/Fax

Practice location:
  • Phone: 818-508-2681
  • Fax: 818-508-2699
Mailing address:
  • Phone: 818-508-2681
  • Fax: 818-508-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: