Healthcare Provider Details

I. General information

NPI: 1497752364
Provider Name (Legal Business Name): VICTOR K LUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 04/06/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

3020 MERCER UNIVERSITY DR 100
CHAMBLEE GA
30341-4145
US

IV. Provider business mailing address

3020 MERCER UNIVERSITY DR 100
CHAMBLEE GA
30341-4145
US

V. Phone/Fax

Practice location:
  • Phone: 770-458-3383
  • Fax: 770-458-9958
Mailing address:
  • Phone: 770-458-3383
  • Fax: 770-458-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18694
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: