Healthcare Provider Details

I. General information

NPI: 1144147489
Provider Name (Legal Business Name): JENNIFER LU, D.O. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W CARROLL AVE STE 104
GLENDORA CA
91741-4704
US

IV. Provider business mailing address

412 W CARROLL AVE STE 104
GLENDORA CA
91741-4704
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-1413
  • Fax:
Mailing address:
  • Phone: 626-963-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER LU
Title or Position: FAMILY MEDICINE PHYSICIAN
Credential: DO
Phone: 626-963-1413