Provider Demographics
NPI:1205937109
Name:LU, ELIZABETH J (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:LU
Suffix:
Gender:F
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:PO BOX 17960
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-7960
Mailing Address - Country:US
Mailing Address - Phone:818-705-4220
Mailing Address - Fax:818-705-4041
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:SUITE 410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5192
Practice Address - Country:US
Practice Address - Phone:310-274-2525
Practice Address - Fax:310-274-5530
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53437207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G534370OtherBLUE SHIELD
CA00G534370OtherBLUE SHIELD
A52523Medicare UPIN