MEDICARE: DAVID Q LU MD INC

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	207L00000X	Anesthesiology Physician	A85335	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A853350	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1437169307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID Q LU MD INC

Provider Business Mailing Address
First Line	:	210 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3807
Country	:	US
Telephone Number	:	714-347-1010
Fax Number	:	714-647-1245

Provider Business Practice Location Address
First Line	:	2880 ATLANTIC AVE STE 180
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1736
Country	:	US
Telephone Number	:	562-426-2606
Fax Number	:	562-426-5866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID QING LU
Credential	:	MD
Telephone Number	:	818-845-6206

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/17/2010

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