Healthcare Provider Details

I. General information

NPI: 1508060534
Provider Name (Legal Business Name): STEPHEN LUI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 MARTIN LUTHER KING JR BLVD SUITE 5
LYNWOOD CA
90262-3509
US

IV. Provider business mailing address

PO BOX 10693
NEWPORT BEACH CA
92658-5005
US

V. Phone/Fax

Practice location:
  • Phone: 310-763-7504
  • Fax: 310-763-7573
Mailing address:
  • Phone: 310-763-7504
  • Fax: 310-763-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberA87511
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN LUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-840-6219