Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 106058 | CA |
NPI | 1003445057 |
---|---|
Provider Name | Lu Tian |
First Address | Sacramento, CA 95815-1601 |
Second Address | Sacramento, CA 95828-9335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2020 |
Last Update Date | 25/08/2021 |