Provider Demographics
NPI:1518371384
Name:LUI, MICKEY (DO)
Entity Type:Individual
Prefix:
First Name:MICKEY
Middle Name:
Last Name:LUI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 S DIAMOND BAR BLVD STE 784
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2203
Mailing Address - Country:US
Mailing Address - Phone:510-859-7640
Mailing Address - Fax:888-939-4225
Practice Address - Street 1:25333 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0210
Practice Address - Country:US
Practice Address - Phone:510-859-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14387208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation