Basic Information
| Provider Information | |||||||||
| NPI: | 1689701807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAI | ||||||||
| FirstName: | SANDY | ||||||||
| MiddleName: | YI-SHUAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 730 | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917850730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262566010 | ||||||||
| FaxNumber: | 8558984054 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 HUNTINGTON DR STE F | ||||||||
| Address2: | |||||||||
| City: | SAN MARINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911082357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262701580 | ||||||||
| FaxNumber: | 6263990478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A67557 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.