Healthcare Provider Details

I. General information

NPI: 1134951171
Provider Name (Legal Business Name): DEBORAH D LU MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 S AZUSA AVE STE 306
HACIENDA HEIGHTS CA
91745-6854
US

IV. Provider business mailing address

1850 S AZUSA AVE STE 306
HACIENDA HEIGHTS CA
91745-6854
US

V. Phone/Fax

Practice location:
  • Phone: 626-913-2055
  • Fax: 626-913-2085
Mailing address:
  • Phone: 626-913-2055
  • Fax: 626-913-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH LU
Title or Position: OWNER
Credential: MD
Phone: 626-913-2055