MEDICARE: KENT M LAI DO

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	207Q00000X	Family Medicine Physician	PENDING	CA

General Provider Information

NPI Number	:	1710402672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT M LAI DO

Provider Business Mailing Address
First Line	:	PO BOX 3067
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95992-3067
Country	:	US
Telephone Number	:	530-751-4784
Fax Number	:	530-751-4906

Provider Business Practice Location Address
First Line	:	1233 PLUMAS ST STE A
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3410
Country	:	US
Telephone Number	:	530-671-2020
Fax Number	:	530-671-3096

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	12/22/2021

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Directions to “ KENT M LAI DO” Practice Location

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