Provider Demographics
NPI:1821094970
Name:LUU, THUAN MOC (DPM, DC)
Entity Type:Individual
Prefix:DR
First Name:THUAN
Middle Name:MOC
Last Name:LUU
Suffix:
Gender:M
Credentials:DPM, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 SENTER RD
Mailing Address - Street 2:STE 18
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2608
Mailing Address - Country:US
Mailing Address - Phone:408-286-1234
Mailing Address - Fax:
Practice Address - Street 1:2114 SENTER RD
Practice Address - Street 2:STE 18
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-286-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26437111N00000X
CAE3961213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39610Medicaid
CA000E39611Medicaid
CA000E39612Medicaid
CADC26437OtherCHIROPRACTIC
CAU53195Medicare UPIN
CA000E39610Medicare ID - Type Unspecified
CA000E39610Medicaid
CADC0264372Medicare ID - Type Unspecified
CA000E39611Medicare ID - Type Unspecified
CADC0264370Medicare ID - Type Unspecified
CA000E39612Medicaid