MEDICARE: LIQUN 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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1669241121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIQUN LU

Provider Business Mailing Address
First Line	:	3765 LONGS PEAK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3765 LONGS PEAK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0101
Country	:	US
Telephone Number	:	725-666-7001
Fax Number	:

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

Provider Enumeration Date	:	12/26/2023
Last Update Date	:	12/26/2023

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Directions to “ LIQUN LU ” Practice Location

Language	Start Address	Practice Location

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