MEDICARE: JOSEPHINE SHUK FUN 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	2080A0000X	Pediatric Adolescent Medicine Physician	A105500	CA

General Provider Information

NPI Number	:	1669630711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE SHUK FUN LAU M.D.

Provider Business Mailing Address
First Line	:	3333 CALIFORNIA ST STE 245
Second Line	:	ADOLESCENT MEDICINE FELLOWSHIP PROGRAM, UNIVERSITY OF C
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-6210
Country	:	US
Telephone Number	:	415-476-9615
Fax Number	:	415-476-6106

Provider Business Practice Location Address
First Line	:	3333 CALIFORNIA ST STE 245
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-6210
Country	:	US
Telephone Number	:	415-353-2002
Fax Number	:	415-353-2466

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	12/21/2021

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