Provider Demographics
NPI:1578520763
Name:LUU, MICHAEL QUOC (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:QUOC
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 1:3452 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3142
Mailing Address - Country:US
Mailing Address - Phone:626-793-2885
Mailing Address - Fax:626-793-6262
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-793-4139
Practice Address - Fax:626-304-8082
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60018207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110126918OtherRAIL ROAD MEDICARE
CAP00905546OtherRAILROAD MEDICARE
CAG60018OtherBLUE SHIELD
CA110126918OtherRAIL ROAD MEDICARE
CAP00905546OtherRAILROAD MEDICARE
CABH205ZMedicare PIN