Provider Demographics
NPI:1043696677
Name:LAU, JIMMY (DDS)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-3044
Mailing Address - Country:US
Mailing Address - Phone:626-280-5280
Mailing Address - Fax:
Practice Address - Street 1:914 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-3044
Practice Address - Country:US
Practice Address - Phone:888-988-4066
Practice Address - Fax:847-496-4850
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice