Healthcare Provider Details

I. General information

NPI: 1093366049
Provider Name (Legal Business Name): JEFFREY LAI, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2019
Last Update Date: 03/01/2020
Certification Date: 03/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 LOMITA BLVD STE 202
TORRANCE CA
90505-1910
US

IV. Provider business mailing address

3655 LOMITA BLVD STE 202
TORRANCE CA
90505-1910
US

V. Phone/Fax

Practice location:
  • Phone: 424-363-7488
  • Fax: 424-363-7499
Mailing address:
  • Phone: 424-363-7488
  • Fax: 424-363-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY C LAI
Title or Position: PRESIDENT
Credential: MD
Phone: 424-363-7488