Active NPI
Jessica P. Wu, M.D.
- Dermatology Physician
- Los Angeles, CA
National Provider Identifier
1457412231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- G79774A
- Practice address
- 11600 Wilshire Blvd
Suite 322
Los Angeles, CA 90025-5781 - Phone
- (310) 473-5878
- Fax
- (310) 231-8661
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | G79774A | CA | Primary |
Addresses
Primary practice location
11600 Wilshire Blvd
Suite 322
Los Angeles, CA 90025-5781
Mailing address
11600 Wilshire Blvd
Suite 322
Los Angeles, CA 90025-5781
Phone (310) 473-5878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2015 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79774 | CA | MD | Pharmacist |
| G79774A | CA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457412231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11600 WILSHIRE BLVD",
"address_2": "SUITE 322",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255781",
"telephone_number": "310-473-5878",
"fax_number": "310-231-8661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11600 WILSHIRE BLVD",
"address_2": "SUITE 322",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255781",
"telephone_number": "310-473-5878",
"fax_number": "310-231-8661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WU",
"first_name": "JESSICA",
"middle_name": "P.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "G79774A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.