MEDICARE: MICHELLE KANG-NI LU PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1407473309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KANG-NI LU PA-C

Provider Business Mailing Address
First Line	:	12222 N CENTRAL EXPY STE 420
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3755
Country	:	US
Telephone Number	:	972-985-2797
Fax Number	:	972-985-4797

Provider Business Practice Location Address
First Line	:	12222 N CENTRAL EXPY STE 420
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3755
Country	:	US
Telephone Number	:	972-985-2797
Fax Number	:	972-985-4797

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	05/28/2026

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