MEDICARE: BACHOUR-LU DENTAL CORPORATION

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1750225223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACHOUR-LU DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1941 HUNTINGTON DR STE H
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 HUNTINGTON DR STE H
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4995
Country	:	US
Telephone Number	:	626-658-7882
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN LU
Credential	:
Telephone Number	:	213-807-3859

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/24/2026

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