Provider Demographics
NPI:1457412231
Name:WU, JESSICA P (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:P
Last Name:WU
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Gender:F
Credentials:MD
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Mailing Address - Street 1:11600 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 322
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5781
Mailing Address - Country:US
Mailing Address - Phone:310-473-5878
Mailing Address - Fax:310-231-8661
Practice Address - Street 1:11600 WILSHIRE BLVD
Practice Address - Street 2:SUITE 322
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5781
Practice Address - Country:US
Practice Address - Phone:310-473-5878
Practice Address - Fax:310-231-8661
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG79774A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG46059Medicare UPIN