Provider Demographics
NPI:1457536955
Name:PAUL P. M. LUO,M.D.INC
Entity Type:Organization
Organization Name:PAUL P. M. LUO,M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PM
Authorized Official - Last Name:LUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-464-9119
Mailing Address - Street 1:5385 WALNUT AVE
Mailing Address - Street 2:# 7
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2605
Mailing Address - Country:US
Mailing Address - Phone:909-464-9119
Mailing Address - Fax:909-464-2201
Practice Address - Street 1:5385 WALNUT AVE
Practice Address - Street 2:# 7
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2605
Practice Address - Country:US
Practice Address - Phone:909-464-9119
Practice Address - Fax:909-464-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37082208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A370820Medicaid
CAC08343Medicare UPIN