Provider Demographics
NPI:1326381286
Name:LUU, TINA THU NGA (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:THU NGA
Last Name:LUU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23530 KINGSLAND BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7466
Mailing Address - Country:US
Mailing Address - Phone:832-522-8751
Mailing Address - Fax:832-522-8770
Practice Address - Street 1:23530 KINGSLAND BLVD STE 130
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:832-522-8751
Practice Address - Fax:832-522-8770
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9188207Q00000X
OH127750261QP2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364941003Medicaid