Basic Information
| Provider Information | |||||||||
| NPI: | 1184651820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUE | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 PARNASSUS AVENUE | ||||||||
| Address2: | SUITE A610 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154761611 | ||||||||
| FaxNumber: | 4154768849 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PARNASSUS AVE | ||||||||
| Address2: | SUITE A610 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153532200 | ||||||||
| FaxNumber: | 4153532480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | A33382 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 00A333820 | 05 | CA | MEDICAID |