Provider Demographics
NPI:1144212614
Name:LU, HUNG S (MD)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:S
Last Name:LU
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 1:4710 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3834
Mailing Address - Country:US
Mailing Address - Phone:602-267-8600
Mailing Address - Fax:602-522-1800
Practice Address - Street 1:4710 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3834
Practice Address - Country:US
Practice Address - Phone:602-267-8600
Practice Address - Fax:602-522-1800
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26003207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ415861Medicaid
AZF47492Medicare UPIN
AZ415861Medicaid