Provider Demographics
NPI:1124100672
Name:LUU, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LUU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 RAINIER AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2439
Mailing Address - Country:US
Mailing Address - Phone:206-723-2889
Mailing Address - Fax:206-723-4939
Practice Address - Street 1:5420 RAINIER AVE SOUTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2439
Practice Address - Country:US
Practice Address - Phone:206-723-2889
Practice Address - Fax:206-723-4939
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000032942208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1095132Medicaid
WA217000465Medicare ID - Type Unspecified
WA1095132Medicaid