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General NPI Number Information
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NPI Number | 1669768511
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Entity Type | Individual
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Provider Name | JONATHAN TONY LAU M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 4212 N 16TH ST
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City | PHOENIX
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State | AZ
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Zip | 85016-5319
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Country | US
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Telephone | 602-263-1200
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Fax |
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Provider Business Mailing Address
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Address Line | PIMC - PNC PO BOX 31001-0698
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City | PASADENA
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State | CA
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Zip | 91110-0698
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Country | US
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Telephone | 602-263-1200
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A122262
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License Number State | CA
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