Organization Name: | AT JESSICA LUU DPM INC |
NPI Number: | 1043408834 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JESSICA LUU (PRESIDENT) |
Mailing Address: | 15038 Imperial Hwy La Mirada |
State: | CA US |
Postal Code: | 906381301 |
Phone Number: | 5629478200 |
Fax Number: | |
NPI Enumeration Date: | 10/05/2007 |
NPI Last Update Date: | 10/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | E4343 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |