Provider Demographics
NPI:1386673606
Name:LU, SHELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:LU
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902846306OtherGROUP NPI
CAGR0016910OtherGROUP MEDICAID PIN
CAP00067726OtherRAILROAD MEDICARE
CA1356390009OtherGROUP NPI
CACE1617OtherGROUP RAILROAD MEDICARE
CAW18762OtherGROUP MEDICARE PIN
CAGR0100430OtherGROUP MEDICAL
CA00G517430OtherBLUE SHIELD
CA00G517430Medicaid
CAW11675OtherGROUP MEDICARE PIN
CAW18762OtherGROUP MEDICARE PIN
CAP00067726OtherRAILROAD MEDICARE