Provider Demographics
NPI:1548373491
Name:LU, SCARLETT TAN (DO)
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:TAN
Last Name:LU
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 CORPORATE WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3895
Mailing Address - Country:US
Mailing Address - Phone:916-661-5336
Mailing Address - Fax:916-382-4630
Practice Address - Street 1:1102 CORPORATE WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3895
Practice Address - Country:US
Practice Address - Phone:916-661-5336
Practice Address - Fax:916-382-4630
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8387207Q00000X
HIDOS 1061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000286781OtherHMSA BILLING NUMBER
HI634792-01Medicaid
HI634792-01Medicaid
HI0000286781OtherHMSA BILLING NUMBER
HIBY923ZMedicare PIN