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NPI Code Detail

MEDICARE: DR. JOHNNY LU MD

MEDICARE: DR. JOHNNY LU MD
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
1208000000XPediatrics Physician116257874TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275776528
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHNNY LU MD
Provider Business Mailing Address
First Line : 299 WASHINGTON AVE
Second Line :
City : HAMDEN
State : CT
Zip : 06518-3026
Country : US
Telephone Number : 203-288-4288
Fax Number : 203-288-1566
Provider Business Practice Location Address
First Line : 299 WASHINGTON AVE STE LL
Second Line :
City : HAMDEN
State : CT
Zip : 06518-3039
Country : US
Telephone Number : 203-288-4288
Fax Number : 855-414-4010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2009
Last Update Date : 05/03/2021

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