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General NPI Number Information
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NPI Number | 1376893974
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Entity Type | Individual
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Provider Name | KENNETH ETHAN LAI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 7208 W SAND LAKE RD STE 305
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City | ORLANDO
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State | FL
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Zip | 32819-5279
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Country | US
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Telephone | 407-799-8808
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Fax | 407-440-4307
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Provider Business Mailing Address
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Address Line | 6968 PHILLIPS RESERVE CT FL 7208W
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City | ORLANDO
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State | FL
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Zip | 32819-7809
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Country | US
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Telephone | 407-558-0188
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Fax | 407-440-4307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 114891
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License Number State | FL
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