Provider Demographics
NPI:1598862328
Name:LU, KUN-HONG (LISW)
Entity Type:Individual
Prefix:
First Name:KUN-HONG
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-0596
Mailing Address - Country:US
Mailing Address - Phone:641-236-8811
Mailing Address - Fax:641-236-8818
Practice Address - Street 1:827 HIGH ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2132
Practice Address - Country:US
Practice Address - Phone:641-236-8811
Practice Address - Fax:641-236-8818
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21077104100000X
IA067691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker