MEDICARE: DR. BENJAMIN C.K. LAU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	A60654	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144211665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN C.K. LAU M.D.

Provider Business Mailing Address
First Line	:	4306 GEARY BLVD
Second Line	:	STE. 201
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3059
Country	:	US
Telephone Number	:	415-876-6400
Fax Number	:	415-876-6402

Provider Business Practice Location Address
First Line	:	4306 GEARY BLVD
Second Line	:	STE. 201
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3059
Country	:	US
Telephone Number	:	415-876-6400
Fax Number	:	415-876-6402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	09/13/2010

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