Provider Demographics
NPI:1639190341
Name:LU, SHI PING (LAC PHD)
Entity Type:Individual
Prefix:MRS
First Name:SHI PING
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:LAC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 LANYARD DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1507
Mailing Address - Country:US
Mailing Address - Phone:650-654-4043
Mailing Address - Fax:
Practice Address - Street 1:1800 BROADWAY ST
Practice Address - Street 2:STE 2
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2086
Practice Address - Country:US
Practice Address - Phone:650-568-0608
Practice Address - Fax:650-568-0678
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0092290OtherBLUE SHIELD OF CA
295769LUROtherUNITED HEALTHCARE