MEDICARE: ELAINE LANFAN LU DDS DENTAL CORP

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	122300000X	Dentist	56199	CA
2	1223G0001X	General Practice Dentistry	56199	CA

General Provider Information

NPI Number	:	1235453200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAINE LANFAN LU DDS DENTAL CORP

Provider Business Mailing Address
First Line	:	325 CALIFORNIA ST
Second Line	:	UNIT B
City	:	ARCADIA
State	:	CA
Zip	:	91006-3717
Country	:	US
Telephone Number	:	626-446-5356
Fax Number	:	626-446-5356

Provider Business Practice Location Address
First Line	:	121 W COLORADO BLVD
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-2805
Country	:	US
Telephone Number	:	626-278-3248
Fax Number	:	626-446-5356

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELAINE F LU
Credential	:	DDS
Telephone Number	:	626-297-3246

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/19/2010

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