Provider Demographics
NPI:1407186414
Name:LU, THUY PHUNG (MD)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:PHUNG
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 1:8701 SHORE RD
Mailing Address - Street 2:APARTMENT 413
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8701 SHORE RD
Practice Address - Street 2:APARTMENT 413
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4254
Practice Address - Country:US
Practice Address - Phone:718-238-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program