Healthcare Provider Details

I. General information

NPI: 1790697910
Provider Name (Legal Business Name): IVY TING-YI LU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W LEMON AVE
ARCADIA CA
91007-7945
US

IV. Provider business mailing address

NO.108, ZIMIAN ROAD
KAOHISUNG ZUOYING DISTRICT
81348
TW

V. Phone/Fax

Practice location:
  • Phone: 626-390-0019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: