MEDICARE: SEAN X. LUO, M.D., PH.D., LLC

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	261QM2500X	Medical Specialty Clinic/Center	60261934	NY

General Provider Information

NPI Number	:	1710306956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAN X. LUO, M.D., PH.D., LLC

Provider Business Mailing Address
First Line	:	215 W 88TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	646-918-3780
Fax Number	:	646-786-3772

Provider Business Practice Location Address
First Line	:	215 W 88TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	646-918-3780
Fax Number	:	646-786-3772

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SEAN XIAO LUO
Credential	:	MD, PHD
Telephone Number	:	646-918-3780

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	10/02/2024

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