Provider Demographics
NPI:1750548640
Name:LUU, THAN (MD)
Entity type:Individual
Prefix:DR
First Name:THAN
Middle Name:
Last Name:LUU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 GARVEY AVE STE I
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-5306
Mailing Address - Country:US
Mailing Address - Phone:626-572-3955
Mailing Address - Fax:626-572-3954
Practice Address - Street 1:9014 GARVEY AVE STE I
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-5306
Practice Address - Country:US
Practice Address - Phone:626-572-3955
Practice Address - Fax:626-572-3954
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101119207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245019835Medicaid
CA1467805739Medicaid
CAAZ588WMedicare PIN
CAAZ588UMedicare PIN