1659479384 NPI number — JOHN LU, PA

Table of content: (NPI 1659479384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659479384 NPI number — JOHN LU, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN LU, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1659479384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11455 FALLBROOK DR
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77065-4238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-897-9966
Provider Business Mailing Address Fax Number:
281-897-8806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11455 FALLBROOK DR
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77065-4238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-897-9966
Provider Business Practice Location Address Fax Number:
281-897-8806
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LU
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-897-9966

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0083LC . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com