Healthcare Provider Details

I. General information

NPI: 1508122979
Provider Name (Legal Business Name): ANGELA LAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 11/19/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

275 W MACARTHUR
OAKLAND CA
94611-5641
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax:
Mailing address:
  • Phone: 510-752-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDR.0065868
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA122977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: