Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | POD-000916 | AZ |
NPI | 1083617781 |
---|---|
Provider Name | Adam Khoa Lu |
First Address | Phoenix, AZ 85048-7871 |
Second Address | Phoenix, AZ 85048-7871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 24/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U88959 | (02) |