MEDICARE: KEPENG LU PA

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	PA1731	NV
2	363A00000X	Physician Assistant	PA0334	NV
3	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1861856601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEPENG LU PA

Provider Business Mailing Address
First Line	:	38 CONGRESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1333
Country	:	US
Telephone Number	:	702-858-3188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2995 S JONES BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5612
Country	:	US
Telephone Number	:	702-805-1880
Fax Number	:	702-805-1880

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	06/10/2019

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Directions to “ KEPENG LU PA” Practice Location

Language	Start Address	Practice Location

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