Provider Demographics
NPI:1043813561
Name:LU, SHUAI
Entity Type:Individual
Prefix:
First Name:SHUAI
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 BENT TWIG LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3810
Mailing Address - Country:US
Mailing Address - Phone:626-999-6697
Mailing Address - Fax:
Practice Address - Street 1:2117 FOOTHILL BLVD STE D
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2902
Practice Address - Country:US
Practice Address - Phone:626-999-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AC15835171100000X
CAAC15835171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist