=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225450745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KANE LAI MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2014
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 S BELLAIRE ST SUITE 222
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-445-9052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2820 STONINGTON CT
-----------------------------------------------------
City | HIGHLANDS RANCH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80126-8015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KANE LAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-281-5263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | 42334
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------