Provider Demographics
NPI:1396181186
Name:LUU, JESSICA TRAN (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TRAN
Last Name:LUU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4894 REGENTS PARK LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3950
Mailing Address - Country:US
Mailing Address - Phone:510-493-0926
Mailing Address - Fax:
Practice Address - Street 1:4894 REGENTS PARK LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3950
Practice Address - Country:US
Practice Address - Phone:510-493-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist