Provider Demographics
NPI:1285262170
Name:LUU, LYDIA AN (MD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:AN
Last Name:LUU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14305 SOUTHCROSS DR W STE 110
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7011
Mailing Address - Country:US
Mailing Address - Phone:651-340-1064
Mailing Address - Fax:
Practice Address - Street 1:14305 SOUTHCROSS DR W STE 110
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7011
Practice Address - Country:US
Practice Address - Phone:651-340-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78540207N00000X, 207ND0101X, 207ND0101X
CODR.0073878207ND0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery