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19331 Business Center Drive Suite 101 Northridge CA 91324 | |
| (818) 886-3500 | |
| (818) 886-1733 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 19331 Business Center Drive, Northridge, California |
| Authorized Official Name and Position | Terence Kien-wa Lau (OWNER / PARTNER) |
| Authorized Official Contact | 8188863500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
19331 Business Center Drive Suite 101 Northridge CA 91324 Ph: (818) 886-3500 | 19331 Business Center Drive Suite 101 Northridge CA 91324 Ph: (818) 886-3500 |
| NPI Number | 1942490602 |
|---|---|
| Provider Enumeration Date | 07/30/2007 |
| Last Update Date | 08/21/2024 |
| Medicare PECOS PAC ID | 0345430898 |
|---|---|
| Medicare Enrollment ID | O20241007001071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942490602 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Kayla Gale Lau |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891366357 PECOS PAC ID: 5092246504 Enrollment ID: I20241008000756 |
| Provider Name | Terence Lau |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1811187784 PECOS PAC ID: 5890985345 Enrollment ID: I20241009002314 |
| Provider Name | Casey Kien Chung Lau |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1891985917 PECOS PAC ID: 1254521701 Enrollment ID: I20241021003865 |
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