Provider Demographics
NPI:1922205905
Name:LEW, HAU LONG (DC)
Entity Type:Individual
Prefix:
First Name:HAU
Middle Name:LONG
Last Name:LEW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-0354
Mailing Address - Country:US
Mailing Address - Phone:626-288-8879
Mailing Address - Fax:626-288-8569
Practice Address - Street 1:8736 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3331
Practice Address - Country:US
Practice Address - Phone:626-288-8879
Practice Address - Fax:626-288-8569
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0191890Medicaid
CADC19189Medicare ID - Type Unspecified
CAU16936Medicare UPIN