Provider Demographics
NPI:1023691474
Name:LU, RACHEL KIM (FNP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:KIM
Last Name:LU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ALTON PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5032
Mailing Address - Country:US
Mailing Address - Phone:949-552-8282
Mailing Address - Fax:
Practice Address - Street 1:2500 ALTON PKWY STE 108
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5032
Practice Address - Country:US
Practice Address - Phone:949-552-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF02210496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine