MEDICARE: BEN LU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1770474629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN LU

Provider Business Mailing Address
First Line	:	5807 UNIVERSITY AVE STE 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5807 UNIVERSITY AVE STE 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6295
Country	:	US
Telephone Number	:	858-600-1098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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Directions to “ BEN LU ” Practice Location

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