Provider Demographics
NPI:1407540644
Name:FANG, LUO LUO
Entity Type:Individual
Prefix:
First Name:LUO LUO
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LU LU
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:MANHATTAN VA, 423 E 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MANHATTAN VA, 423 E 23RD STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program