Provider Demographics
NPI:1871233882
Name:RONG D. LU, D.M.D., P.C.
Entity type:Organization
Organization Name:RONG D. LU, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAKEI
Authorized Official - Middle Name:LU
Authorized Official - Last Name:LON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-873-0876
Mailing Address - Street 1:801 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4422
Practice Address - Country:US
Practice Address - Phone:510-873-0876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty