Provider Demographics
NPI:1306207212
Name:LU, THANH TRUC THUY (MD)
Entity Type:Individual
Prefix:DR
First Name:THANH TRUC
Middle Name:THUY
Last Name:LU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THANH TRUC
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST FL 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3400
Practice Address - Fax:916-733-5384
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA161146208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA161146OtherMEDICAL STATE LICENSE