Healthcare Provider Details

I. General information

NPI: 1225041262
Provider Name (Legal Business Name): ALEX KAM LAU LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 BROADWAY ST
REDWOOD CITY CA
94063
US

IV. Provider business mailing address

1675 BROADWAY ST
REDWOOD CITY CA
94063
US

V. Phone/Fax

Practice location:
  • Phone: 650-799-9088
  • Fax: 650-368-1370
Mailing address:
  • Phone: 650-799-9088
  • Fax: 650-368-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: