Provider Demographics
NPI:1285818666
Name:LU, JASON SHIHYI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SHIHYI
Last Name:LU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10168 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5302
Mailing Address - Country:US
Mailing Address - Phone:951-900-4761
Mailing Address - Fax:
Practice Address - Street 1:10168 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5302
Practice Address - Country:US
Practice Address - Phone:951-900-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist