Provider Demographics
NPI:1801574454
Name:LUU, YEN KIM
Entity type:Individual
Prefix:
First Name:YEN
Middle Name:KIM
Last Name:LUU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 PRAIRIE CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4484
Mailing Address - Country:US
Mailing Address - Phone:469-422-5824
Mailing Address - Fax:
Practice Address - Street 1:1226 W MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6304
Practice Address - Country:US
Practice Address - Phone:972-396-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy