Provider Demographics
NPI:1104179035
Name:LU, YING (PHD)
Entity Type:Individual
Prefix:DR
First Name:YING
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 NOROCCO CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2104
Mailing Address - Country:US
Mailing Address - Phone:510-688-1486
Mailing Address - Fax:
Practice Address - Street 1:39812 MISSION BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3056
Practice Address - Country:US
Practice Address - Phone:510-688-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist