Provider Demographics
NPI:1013098516
Name:LU, CHONG-PING CARL (MD)
Entity Type:Individual
Prefix:
First Name:CHONG-PING
Middle Name:CARL
Last Name:LU
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 1:1000 E LATHAM AVE STE E
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4409
Mailing Address - Country:US
Mailing Address - Phone:951-925-7653
Mailing Address - Fax:951-925-1122
Practice Address - Street 1:1000 E LATHAM AVE STE E
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4409
Practice Address - Country:US
Practice Address - Phone:951-925-7653
Practice Address - Fax:951-925-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35138207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27696Medicare UPIN