Provider Demographics
NPI:1295099356
Name:LU, SHUN SOPHIA (DPM)
Entity type:Individual
Prefix:
First Name:SHUN
Middle Name:SOPHIA
Last Name:LU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 S AZUSA AVE.
Mailing Address - Street 2:SUITE #306
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6854
Mailing Address - Country:US
Mailing Address - Phone:626-824-9772
Mailing Address - Fax:
Practice Address - Street 1:1850 S AZUSA AVE.
Practice Address - Street 2:SUITE #306
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6854
Practice Address - Country:US
Practice Address - Phone:626-824-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5162213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist