Healthcare Provider Details

I. General information

NPI: 1407531239
Provider Name (Legal Business Name): KEVIN LAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FRANKLIN AVE STE UPPER
GARDEN CITY NY
11530-1886
US

IV. Provider business mailing address

1299 CORPORATE DR APT 1823
WESTBURY NY
11590-6657
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-8890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number341942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: