Provider Demographics
NPI:1447612049
Name:DING, MICHELLE MENG LU
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MENG LU
Last Name:DING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2518
Mailing Address - Country:US
Mailing Address - Phone:626-376-6070
Mailing Address - Fax:
Practice Address - Street 1:844 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2518
Practice Address - Country:US
Practice Address - Phone:626-376-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program