Provider Demographics
NPI:1235453200
Name:ELAINE LANFAN LU DDS DENTAL CORP
Entity Type:Organization
Organization Name:ELAINE LANFAN LU DDS DENTAL CORP
Other - Org Name:HEALTHY LIFE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-297-3246
Mailing Address - Street 1:325 CALIFORNIA ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3717
Mailing Address - Country:US
Mailing Address - Phone:626-446-5356
Mailing Address - Fax:626-446-5356
Practice Address - Street 1:121 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2805
Practice Address - Country:US
Practice Address - Phone:626-278-3248
Practice Address - Fax:626-446-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56199122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty