1710196910 NPI number — NU T. LU MD

Table of content: NU T. LU MD (NPI 1710196910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710196910 NPI number — NU T. LU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LU
Provider First Name:
NU
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710196910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23929 MCBEAN PKWY
Provider Second Line Business Mailing Address:
#215
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-4466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-255-5350
Provider Business Mailing Address Fax Number:
666-255-9907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23929 MCBEAN PKWY
Provider Second Line Business Practice Location Address:
215
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-4466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-661-2555
Provider Business Practice Location Address Fax Number:
661-255-9907
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  A99720 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BP2-0023689 . This is a "INSTITUTIONAL PERMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1740429885 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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