1194216457 NPI number — CHEA LU DO

Table of content: CHEA LU DO (NPI 1194216457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194216457 NPI number — CHEA LU DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LU
Provider First Name:
CHEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194216457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
367 S GULPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-835-9870
Provider Business Mailing Address Fax Number:
702-835-9883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6850 N DURANGO DR STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149-4596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-835-9870
Provider Business Practice Location Address Fax Number:
702-835-9883
Provider Enumeration Date:
05/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  DO2973 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: V69986 . This is a "MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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