Provider Demographics
NPI:1609866078
Name:FU, JUIAN-JUIAN L (MD & PHD)
Entity Type:Individual
Prefix:DR
First Name:JUIAN-JUIAN
Middle Name:L
Last Name:FU
Suffix:
Gender:F
Credentials:MD & PHD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:L
Other - Last Name:FU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD & PHD
Mailing Address - Street 1:861 CORONADO CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3992
Mailing Address - Country:US
Mailing Address - Phone:702-257-7546
Mailing Address - Fax:702-870-4824
Practice Address - Street 1:861 CORONADO CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3992
Practice Address - Country:US
Practice Address - Phone:702-257-7546
Practice Address - Fax:702-870-4824
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH055772207N00000X
NV16987207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000016209OtherANTHEM/BCBS
OH0320040OtherUNITED HEALTHCARE
OH55772OtherCHOICE CARE/HUMANA
OH0787840Medicaid
OH311292224OtherOTHER INSURANCE CARRIERS
OH070004524OtherRAILROAD MEDICARE