Provider Demographics
NPI:1306890025
Name:LUI, ALBERT GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:GORDON
Last Name:LUI
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 1:31292 ALPINE MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9462
Mailing Address - Country:US
Mailing Address - Phone:530-474-3390
Mailing Address - Fax:
Practice Address - Street 1:31292 ALPINE MEADOWS RD
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9462
Practice Address - Country:US
Practice Address - Phone:530-474-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15106Medicare UPIN
00G519270Medicare PIN