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General NPI Number Information
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NPI Number | 1083896344
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Entity Type | Organization
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Legal Business Name | SHANHONG LU
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 830 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2137
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Country | US
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Telephone | 530-926-1000
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Fax | 530-926-0375
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-0218
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Country | US
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Telephone | 530-926-1000
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Fax | 530-926-0375
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANHONG LU
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Credential | M.C.
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Telephone | 530-926-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A61944
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License Number State | CA
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