Provider Demographics
NPI:1972847598
Name:LUU, YEN HONG (PA)
Entity type:Individual
Prefix:
First Name:YEN
Middle Name:HONG
Last Name:LUU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 S LAKESHORE DR
Mailing Address - Street 2:APT 105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7164
Mailing Address - Country:US
Mailing Address - Phone:623-297-9822
Mailing Address - Fax:
Practice Address - Street 1:4630 S LAKESHORE DR
Practice Address - Street 2:APT 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7164
Practice Address - Country:US
Practice Address - Phone:623-297-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5301363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical