Active NPI
Irene O Lao, M.D.
- Dermatology Physician
- Duarte, CA
National Provider Identifier
1235113457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- A41174
- Practice address
- 931 Buena Vista St
Suite 201
Duarte, CA 91010-1712 - Phone
- (626) 303-4626
- NPI assigned
- Dec 1, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | A41174 | CA | Primary |
Addresses
Primary practice location
931 Buena Vista St
Suite 201
Duarte, CA 91010-1712
Mailing address
931 Buena Vista St
Suite 201
Duarte, CA 91010-1712
Phone (626) 303-4626
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A411740 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41174 | CA | MD | Licensed Psychiatric Technician |
| A41174 | CA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430784000000",
"number": "1235113457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 BUENA VISTA ST",
"address_2": "SUITE 201",
"city": "DUARTE",
"state": "CA",
"postal_code": "910101712",
"telephone_number": "626-303-4626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "931 BUENA VISTA ST",
"address_2": "SUITE 201",
"city": "DUARTE",
"state": "CA",
"postal_code": "910101712",
"telephone_number": "626-303-4626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAO",
"first_name": "IRENE",
"middle_name": "O",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-01",
"last_updated": "2015-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "A41174",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A411740",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duarte, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.