Healthcare Provider Details

I. General information

NPI: 1417290701
Provider Name (Legal Business Name): PIN-CHUANG LAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2127
  • Fax:
Mailing address:
  • Phone: 816-235-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberRES.3166
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2022006623
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: