Provider Demographics
NPI:1255515417
Name:LU, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:STE 530
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4509
Mailing Address - Country:US
Mailing Address - Phone:310-371-7801
Mailing Address - Fax:
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 290
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4354
Practice Address - Country:US
Practice Address - Phone:310-371-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF87236Medicare UPIN
CAG66695AMedicare PIN