Provider Demographics
NPI:1194116970
Name:LU, MING-LUNG (NP)
Entity type:Individual
Prefix:
First Name:MING-LUNG
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W ALHAMBRA RD APT 302
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2215
Mailing Address - Country:US
Mailing Address - Phone:626-226-8124
Mailing Address - Fax:
Practice Address - Street 1:3401 W SUNFLOWER AVE STE 225
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6948
Practice Address - Country:US
Practice Address - Phone:714-619-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-14
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001978363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health