Provider Demographics
NPI:1578774253
Name:LUU MEDICAL GROUP
Entity Type:Organization
Organization Name:LUU MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:707-643-0400
Mailing Address - Street 1:2920 SONOMA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3879
Mailing Address - Country:US
Mailing Address - Phone:707-643-0400
Mailing Address - Fax:707-643-0470
Practice Address - Street 1:2920 SONOMA BLVD STE C
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3879
Practice Address - Country:US
Practice Address - Phone:707-643-0400
Practice Address - Fax:707-643-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26223111N00000X
CA20A7354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty