Provider Demographics
NPI:1295920148
Name:LU, ELAINE LANFAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:LANFAN
Last Name:LU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CALIFORNIA ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3717
Mailing Address - Country:US
Mailing Address - Phone:626-297-3246
Mailing Address - Fax:626-446-5356
Practice Address - Street 1:325 CALIFORNIA ST
Practice Address - Street 2:UNIT B
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3717
Practice Address - Country:US
Practice Address - Phone:626-297-3246
Practice Address - Fax:626-446-5356
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56199122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice