Provider Demographics
NPI:1366280471
Name:LU, KATHY (NP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 E SANTA CLARA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7232
Mailing Address - Country:US
Mailing Address - Phone:626-400-3328
Mailing Address - Fax:
Practice Address - Street 1:1477 S MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2905
Practice Address - Country:US
Practice Address - Phone:714-782-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner