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General NPI Number Information
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NPI Number | 1467887034
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Entity Type | Organization
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Legal Business Name | LUO INTEGRATIVE MEDICINE LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 201 DARTMOUTH DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2219
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Country | US
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Telephone | 505-301-0791
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Fax |
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Provider Business Mailing Address
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Address Line | 7408 HAWTHORN AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2032
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Country | US
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Telephone | 505-301-0791
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | YIJUAN SUN
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Credential | M.D.
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Telephone | 505-301-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2003-0650
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License Number State | NM
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