Provider Demographics
NPI:1407378565
Name:LU, SHAOJIE (LAC)
Entity Type:Individual
Prefix:
First Name:SHAOJIE
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5178 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1825
Mailing Address - Country:US
Mailing Address - Phone:763-586-6045
Mailing Address - Fax:
Practice Address - Street 1:5178 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-1825
Practice Address - Country:US
Practice Address - Phone:763-586-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist