Healthcare Provider Details

I. General information

NPI: 1912391350
Provider Name (Legal Business Name): LI HAN LAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUCAS LAI

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF ORAL SURGERY 1959 NE PACIFIC ST HEALTH SCIENCES BUILDING B-241
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

DEPARTMENT OF ORAL SURGERY 1959 NE PACIFIC ST BOX 357134
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-5860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR60555009
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901600416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: