Healthcare Provider Details

I. General information

NPI: 1619141223
Provider Name (Legal Business Name): JASON LUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S ARROYO PKWY UNIT 408
PASADENA CA
91105-4133
US

IV. Provider business mailing address

238 S ARROYO PKWY UNIT 408
PASADENA CA
91105-4133
US

V. Phone/Fax

Practice location:
  • Phone: 917-723-5727
  • Fax:
Mailing address:
  • Phone: 917-723-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA104300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: