=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578774253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUU MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2920 SONOMA BLVD STE C
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94590-3879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-643-0400
-----------------------------------------------------
Fax | 707-643-0470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2920 SONOMA BLVD STE C
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94590-3879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-643-0400
-----------------------------------------------------
Fax | 707-643-0470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL C LUU
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 707-643-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC26223
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 20A7354
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------