Healthcare Provider Details

I. General information

NPI: 1265572440
Provider Name (Legal Business Name): GLEN KEE LAU, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GRAND AVE STE. 810
OAKLAND CA
94612-3725
US

IV. Provider business mailing address

80 GRAND AVE STE, 800
OAKLAND CA
94612-3725
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-6950
  • Fax: 510-451-0785
Mailing address:
  • Phone: 510-451-6950
  • Fax: 510-451-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG28241
License Number StateCA

VIII. Authorized Official

Name: DR. GLEN K LAU
Title or Position: OWNER
Credential: M.D.
Phone: 510-451-6950