Healthcare Provider Details

I. General information

NPI: 1467887034
Provider Name (Legal Business Name): LUO INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DARTMOUTH DR SE
ALBUQUERQUE NM
87106-2219
US

IV. Provider business mailing address

7408 HAWTHORN AVE NE
ALBUQUERQUE NM
87113-2032
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-0791
  • Fax:
Mailing address:
  • Phone: 505-301-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2003-0650
License Number StateNM

VIII. Authorized Official

Name: YIJUAN SUN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 505-301-0791