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General NPI Number Information
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NPI Number | 1851312862
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Entity Type | Organization
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Legal Business Name | PACIFIC VALLEY MEDICAL GROUP
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 100 W CALIFORNIA BLVD
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City | PASADENA
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State | CA
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Zip | 91105-3010
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Country | US
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Telephone | 626-397-5000
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Fax | 626-397-2912
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Provider Business Mailing Address
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Address Line | 225 S LAKE AVE 535
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City | PASADENA
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State | CA
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Zip | 91101-3005
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Country | US
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Telephone | 626-795-6596
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Fax | 626-795-8247
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. PHILLIP LAU
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Credential | M.D.
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Telephone | 626-375-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | FNP24854
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License Number State | CA
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