Healthcare Provider Details

I. General information

NPI: 1730114521
Provider Name (Legal Business Name): FRANK FENG LUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FENG LUO M.D.

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 LAUREL ST
PASADENA CA
91103-2329
US

IV. Provider business mailing address

1180 LAUREL ST
PASADENA CA
91103-2329
US

V. Phone/Fax

Practice location:
  • Phone: 626-589-8525
  • Fax: 626-604-9113
Mailing address:
  • Phone: 626-589-8525
  • Fax: 626-604-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA64965
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA64965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: