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General NPI Number Information
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NPI Number | 1063591667
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Entity Type | Organization
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Legal Business Name | GARY T. LAI, M.D.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14335 PIPELINE AVE A-1
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City | CHINO
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State | CA
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Zip | 91710-5642
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Country | US
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Telephone | 909-548-3888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2703
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City | CHINO
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State | CA
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Zip | 91708-2703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | GARY LAI
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Credential | M.D.
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Telephone | 909-548-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A65030
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License Number State | CA
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