Basic Information
Provider Information
NPI: 1568488526
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LU
FirstName: MIN
MiddleName: JANICE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 31309
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900310309
CountryCode: US
TelephoneNumber: 3238653000
FaxNumber:  
Practice Location
Address1: 1441 EASTLAKE AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900891019
CountryCode: US
TelephoneNumber: 3238653000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/14/2006
LastUpdateDate: 10/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XC130396CAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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