Healthcare Provider Details

I. General information

NPI: 1972369379
Provider Name (Legal Business Name): I-WEN LU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 N MAIN ST STE 200
ALPHARETTA GA
30009-8381
US

IV. Provider business mailing address

60 N 23RD ST APT 1606
PHILADELPHIA PA
19103-1569
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-6136
  • Fax:
Mailing address:
  • Phone: 469-323-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123975
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: