MEDICARE: PAULINE LU DDS PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	47637	CA

General Provider Information

NPI Number	:	1003007402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAULINE LU DDS PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3434 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2807
Country	:	US
Telephone Number	:	408-260-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2807
Country	:	US
Telephone Number	:	408-260-0888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAULINE LU
Credential	:	D.D.S.
Telephone Number	:	408-260-0888

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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