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General NPI Number Information
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NPI Number | 1235453200
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Entity Type | Organization
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Legal Business Name | ELAINE LANFAN LU DDS DENTAL CORP
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 121 W COLORADO BLVD
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City | MONROVIA
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State | CA
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Zip | 91016-2805
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Country | US
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Telephone | 626-278-3248
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Fax | 626-446-5356
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Provider Business Mailing Address
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Address Line | 325 CALIFORNIA ST UNIT B
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City | ARCADIA
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State | CA
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Zip | 91006-3717
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Country | US
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Telephone | 626-446-5356
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Fax | 626-446-5356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELAINE F LU
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Credential | DDS
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Telephone | 626-297-3246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56199
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56199
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License Number State | CA
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