Healthcare Provider Details

I. General information

NPI: 1437204658
Provider Name (Legal Business Name): MINHTRUONG TONG LAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

IV. Provider business mailing address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

V. Phone/Fax

Practice location:
  • Phone: 408-879-5963
  • Fax:
Mailing address:
  • Phone: 408-879-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA87630
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA87630
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA87630
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA87630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: