Provider Demographics
NPI:1871515163
Name:LU, CHAO-MING CRAIG (MD)
Entity type:Individual
Prefix:
First Name:CHAO-MING
Middle Name:CRAIG
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 S AZUSA AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6854
Mailing Address - Country:US
Mailing Address - Phone:626-913-2055
Mailing Address - Fax:626-913-2085
Practice Address - Street 1:1850 S AZUSA AVE
Practice Address - Street 2:STE 306
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6854
Practice Address - Country:US
Practice Address - Phone:626-913-2055
Practice Address - Fax:626-913-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51490207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514901Medicaid
CAG30595Medicare UPIN
A51490Medicare PIN