MEDICARE: DR. GARY T. LAI 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	207R00000X	Internal Medicine Physician	A65030	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	:	1245332220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY T. LAI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2703
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91708-2703
Country	:	US
Telephone Number	:	909-548-3888
Fax Number	:	909-548-3999

Provider Business Practice Location Address
First Line	:	14335 PIPELINE AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5642
Country	:	US
Telephone Number	:	909-548-3888
Fax Number	:	909-548-3999

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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