Provider Demographics
NPI:1962481036
Name:LUU, ANH-THU JESSICA (DPM)
Entity Type:Individual
Prefix:
First Name:ANH-THU
Middle Name:JESSICA
Last Name:LUU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 50432
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0432
Mailing Address - Country:US
Mailing Address - Phone:562-947-8200
Mailing Address - Fax:562-947-8233
Practice Address - Street 1:15038 IMPERIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1301
Practice Address - Country:US
Practice Address - Phone:562-947-8200
Practice Address - Fax:562-947-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4343213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4343Medicare PIN