MEDICARE: KIMBERLY BONNIE LUU

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	363A00000X	Physician Assistant	PA16525	TX
2	363AM0700X	Medical Physician Assistant	PA16525	TX

General Provider Information

NPI Number	:	1063143352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BONNIE LUU

Provider Business Mailing Address
First Line	:	7777 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2571
Country	:	US
Telephone Number	:	972-566-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2571
Country	:	US
Telephone Number	:	972-566-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2022
Last Update Date	:	02/16/2026

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Directions to “ KIMBERLY BONNIE LUU ” Practice Location

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