Provider Demographics
NPI:1720030745
Name:LUU, THIEN TIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THIEN
Middle Name:TIEN
Last Name:LUU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W 21ST ST
Mailing Address - Street 2:#E-2
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4087
Mailing Address - Country:US
Mailing Address - Phone:575-762-3726
Mailing Address - Fax:575-762-3727
Practice Address - Street 1:2000 W 21ST ST
Practice Address - Street 2:#E-2
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4087
Practice Address - Country:US
Practice Address - Phone:575-762-3726
Practice Address - Fax:575-762-3727
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-70208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33779Medicaid