Provider Demographics
NPI:1235474008
Name:KAN, LAI MAN (NP)
Entity type:Individual
Prefix:
First Name:LAI MAN
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 JIMMY CARTER BLVD
Mailing Address - Street 2:BUILDING 1400 SUITE 1490
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1228
Mailing Address - Country:US
Mailing Address - Phone:770-817-9766
Mailing Address - Fax:
Practice Address - Street 1:6825 JIMMY CARTER BLVD
Practice Address - Street 2:BUILDING 1400 SUITE 1490
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1228
Practice Address - Country:US
Practice Address - Phone:770-817-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202495163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse