MEDICARE: YEN-TSENG LAI DMD, MS

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	1223P0300X	Periodontics	57709	CA

General Provider Information

NPI Number	:	1295099026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEN-TSENG LAI DMD, MS

Provider Business Mailing Address
First Line	:	2042 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1357
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1357
Country	:	US
Telephone Number	:	408-528-7878
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	11/21/2016

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