Provider Demographics
NPI:1215759766
Name:LU, PINGYUAN
Entity type:Individual
Prefix:MR
First Name:PINGYUAN
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1411 PALE SAN VITORES RD STE 108
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4232
Mailing Address - Country:US
Mailing Address - Phone:671-642-1688
Mailing Address - Fax:
Practice Address - Street 1:1411 PALE SAN VITORES RD STE 108
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4232
Practice Address - Country:US
Practice Address - Phone:671-642-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU1228138713405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional