Provider Demographics
NPI:1417151192
Name:LUU, MANDY (LAC)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:
Last Name:LUU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BICH
Other - Middle Name:YEN
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10408 VACCO ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3328
Mailing Address - Country:US
Mailing Address - Phone:626-636-8701
Mailing Address - Fax:
Practice Address - Street 1:10408 VACCO ST
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3328
Practice Address - Country:US
Practice Address - Phone:626-636-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist