Provider Demographics
NPI:1578746582
Name:LU, ZHI-WEN (MD)
Entity Type:Individual
Prefix:
First Name:ZHI-WEN
Middle Name:
Last Name:LU
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 1:412 W CARROLL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4704
Mailing Address - Country:US
Mailing Address - Phone:626-963-1413
Mailing Address - Fax:626-852-1294
Practice Address - Street 1:412 W CARROLL AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4704
Practice Address - Country:US
Practice Address - Phone:626-963-1413
Practice Address - Fax:626-852-1294
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21951OtherMEDICARE GROUP PTAN
CA00A564210Medicaid
CA1245214261OtherNPI TYPE 2
CAWA56421COtherMEDICARE INDIVIDUAL PTAN