Provider Demographics
NPI: | 1205019049 |
---|---|
Name: | SHARON T. LU DDS, INC. |
Entity Type: | Organization |
Organization Name: | SHARON T. LU DDS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SHARON |
Authorized Official - Middle Name: | TRAN |
Authorized Official - Last Name: | LU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 310-839-8831 |
Mailing Address - Street 1: | 2320 S ROBERTSON BLVD |
Mailing Address - Street 2: | #102 |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90034-2060 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-839-8831 |
Mailing Address - Fax: | 310-839-6981 |
Practice Address - Street 1: | 2320 S ROBERTSON BLVD |
Practice Address - Street 2: | #102 |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90034-2060 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-839-8831 |
Practice Address - Fax: | 310-839-6981 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-17 |
Last Update Date: | 2007-12-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 53920 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |