Provider Demographics
NPI:1457301723
Name:LUU, THUY DUC (MD)
Entity Type:Individual
Prefix:MR
First Name:THUY
Middle Name:DUC
Last Name:LUU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 BOLSA AVE
Mailing Address - Street 2:STE 215 216
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5564
Mailing Address - Country:US
Mailing Address - Phone:714-897-3300
Mailing Address - Fax:714-897-1653
Practice Address - Street 1:9191 BOLSA AVE
Practice Address - Street 2:STE 215 216
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5564
Practice Address - Country:US
Practice Address - Phone:714-897-3300
Practice Address - Fax:714-897-1653
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33349208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A333490Medicaid
CA00A333490Medicaid
A27121Medicare UPIN