MEDICARE: BEIHUA LU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	56854	CA

General Provider Information

NPI Number	:	1013994672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEIHUA LU

Provider Business Mailing Address
First Line	:	3538 BOUGAINVILLE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3538 BOUGAINVILLE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5491
Country	:	US
Telephone Number	:	619-437-2954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2005
Last Update Date	:	03/13/2012

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Directions to “ BEIHUA LU ” Practice Location

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