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NPI Code Detail

MEDICARE: LEWIS WENBUO YIN LUO

MEDICARE: LEWIS WENBUO YIN LUO
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
1122300000XDentist60966563CA
2122300000XDentist0401418018VA

General Provider Information

NPI Number : 1982278115
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEWIS WENBUO YIN LUO
Provider Business Mailing Address
First Line : 22180 LATHAM DR
Second Line :
City : BRISTOL
State : VA
Zip : 24202-4940
Country : US
Telephone Number : 206-724-8158
Fax Number :
Provider Business Practice Location Address
First Line : 616 CAMPUS DR STE 100
Second Line :
City : ABINGDON
State : VA
Zip : 24210-9706
Country : US
Telephone Number : 276-525-4487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2021
Last Update Date : 10/26/2022

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Directions to “ LEWIS WENBUO YIN LUO ” Practice Location

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