Provider Demographics
NPI:1083617781
Name:LU, ADAM KHOA (DPM)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:KHOA
Last Name:LU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 S 34TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7871
Mailing Address - Country:US
Mailing Address - Phone:480-518-1468
Mailing Address - Fax:
Practice Address - Street 1:16423 S 34TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7871
Practice Address - Country:US
Practice Address - Phone:480-518-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2018-10-24
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000916213ES0131X
GA940213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88959Medicare UPIN