Healthcare Provider Details

I. General information

NPI: 1235950635
Provider Name (Legal Business Name): HAIBIN LU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date: 03/16/2026
Reactivation Date: 04/06/2026

III. Provider practice location address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

IV. Provider business mailing address

4323 CANYON CORAL LN
YORBA LINDA CA
92886-8425
US

V. Phone/Fax

Practice location:
  • Phone: 714-470-4057
  • Fax:
Mailing address:
  • Phone: 714-470-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1212299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: