Provider Demographics
NPI:1407625445
Name:LUU, NGHIA
Entity Type:Individual
Prefix:
First Name:NGHIA
Middle Name:
Last Name:LUU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2819
Mailing Address - Country:US
Mailing Address - Phone:626-812-6470
Mailing Address - Fax:
Practice Address - Street 1:1220 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2819
Practice Address - Country:US
Practice Address - Phone:626-812-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist