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General NPI Number Information
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NPI Number | 1225862451
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Entity Type | Organization
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Legal Business Name | XUANYU LU DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/29/2024
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 8202 HUNTINGTON DR UNIT B
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City | SAN GABRIEL
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State | CA
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Zip | 91775
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Country | US
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Telephone | 626-684-2888
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Fax | 626-684-2880
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Provider Business Mailing Address
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Address Line | 8202 HUNTINGTON DR UNIT B
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City | SAN GABRIEL
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State | CA
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Zip | 91775
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Country | US
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Telephone | 626-684-2888
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Fax | 626-684-2880
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Authorized Official
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Title or Position | OWNER
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Name | XUANYU LU
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Credential | DDS
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Telephone | 626-684-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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