Healthcare Provider Details

I. General information

NPI: 1396322418
Provider Name (Legal Business Name): BONNIE WING-WAH LUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE BLDG 7
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE BLDG 7
PALO ALTO CA
94304-1207
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-7669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberA179847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: