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General NPI Number Information
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NPI Number | 1043408834
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Entity Type | Organization
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Legal Business Name | AT JESSICA LUU DPM INC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 15038 IMPERIAL HWY
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City | LA MIRADA
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State | CA
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Zip | 90638-1301
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Country | US
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Telephone | 562-947-8200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50432
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City | IRVINE
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State | CA
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Zip | 92619-0432
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Country | US
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Telephone | 562-947-8200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA LUU
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Credential | DPM
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Telephone | 562-947-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4343
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License Number State | CA
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