Individual
PHAT LU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(844) 308-5003
Mailing address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(760) 631-5000
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
27531
CA
Other
Enumeration date
08/19/2022
Last updated
11/21/2022
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