Basic Information
| Provider Information | |||||||||
| NPI: | 1972847101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAI | ||||||||
| FirstName: | PUI | ||||||||
| MiddleName: | YING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2425 SAMARITAN DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085592011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2425 SAMARITAN DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085592011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | A123550 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 61974 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | A123550 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1972847101 | 05 | WI | MEDICAID |