Provider Demographics
NPI:1093718546
Name:LUU, MYCHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MYCHAEL
Middle Name:
Last Name:LUU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CLARMAR WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1704
Mailing Address - Country:US
Mailing Address - Phone:408-294-7551
Mailing Address - Fax:408-294-7201
Practice Address - Street 1:2050 CLARMAR WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1704
Practice Address - Country:US
Practice Address - Phone:408-294-7551
Practice Address - Fax:408-294-7201
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61816207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A618160Medicaid
CA00A618160Medicare ID - Type Unspecified
CAG81886Medicare UPIN