Provider Demographics
NPI:1538779939
Name:LU, YEN THI (PA)
Entity type:Individual
Prefix:
First Name:YEN
Middle Name:THI
Last Name:LU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:THI
Other - Middle Name:YEN
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:14252 CULVER DR # A918
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0317
Mailing Address - Country:US
Mailing Address - Phone:949-943-9209
Mailing Address - Fax:
Practice Address - Street 1:23832 ROCKFIELD BLVD STE AND220
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2805
Practice Address - Country:US
Practice Address - Phone:949-770-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant