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General NPI Number Information
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NPI Number | 1437141967
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Entity Type | Individual
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Provider Name | CHI KWONG LAI MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 351 NE FRANKLIN ST STE 1
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City | LAKE CITY
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State | FL
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Zip | 32055-3089
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Country | US
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Telephone | 386-292-8250
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Fax | 386-292-7722
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-778-8513
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Fax | 615-628-6877
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 23589
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME129713
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License Number State | FL
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