Provider Demographics
NPI:1740919356
Name:LU, JINGWEI (RD)
Entity type:Individual
Prefix:
First Name:JINGWEI
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JOHNSON AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4553
Mailing Address - Country:US
Mailing Address - Phone:857-498-1385
Mailing Address - Fax:
Practice Address - Street 1:18 JOHNSON AVE APT 14
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4553
Practice Address - Country:US
Practice Address - Phone:857-498-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86172657133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty