Provider Demographics
NPI:1174872634
Name:FU, LAW SAN (MD)
Entity type:Individual
Prefix:
First Name:LAW
Middle Name:SAN
Last Name:FU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AUNG
Other - Middle Name:
Other - Last Name:MYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:753 ,CLASSON AVE
Mailing Address - Street 2:1Q
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:408-886-1608
Mailing Address - Fax:
Practice Address - Street 1:753 ,CLASSON AVE
Practice Address - Street 2:1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:408-886-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program