Healthcare Provider Details

I. General information

NPI: 1891879383
Provider Name (Legal Business Name): ANGELA C LAI L.AC., DIPL.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST STE C
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

510 N PROSPECT AVE 301
REDONDO BEACH CA
90277-3028
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-9567
  • Fax:
Mailing address:
  • Phone: 310-798-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: