Provider Demographics
NPI:1629774294
Name:LUI, JIM (PA)
Entity Type:Individual
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First Name:JIM
Middle Name:
Last Name:LUI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1217 S DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3313
Mailing Address - Country:US
Mailing Address - Phone:626-215-7100
Mailing Address - Fax:
Practice Address - Street 1:2501 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3259
Practice Address - Country:US
Practice Address - Phone:562-776-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-08-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant