Provider Demographics
NPI:1679728117
Name:LU, JESSICA SUSAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SUSAN
Last Name:LU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:SUSAN
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11300 ROCKVILLE PIKE SUITE 714 WCWCW
Mailing Address - Street 2:ONE CENTRAL PLAZA
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-881-9464
Mailing Address - Fax:301-881-9298
Practice Address - Street 1:UCLA NPI SEMEL
Practice Address - Street 2:BOX 951759, C8-225 SEMEL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANOT YET RECEIVED2084P0800X
MDM777992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry