Healthcare Provider Details

I. General information

NPI: 1801709662
Provider Name (Legal Business Name): LULU MAO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 OPTICAL CT
SAN JOSE CA
95138-1400
US

IV. Provider business mailing address

5636 STEVENS CREEK BLVD APT 185
CUPERTINO CA
95014-7623
US

V. Phone/Fax

Practice location:
  • Phone: 408-693-0698
  • Fax:
Mailing address:
  • Phone: 504-296-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberDRN-02162714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: