MEDICARE: JIMMY LAU DDS INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1356829402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMMY LAU DDS INC

Provider Business Mailing Address
First Line	:	914 E GARVEY AVE
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-3044
Country	:	US
Telephone Number	:	626-280-5280
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 E GARVEY AVE
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-3044
Country	:	US
Telephone Number	:	626-280-5280
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JIMMY LAU
Credential	:	DDS
Telephone Number	:	626-348-9433

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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