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General NPI Number Information
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NPI Number | 1659891851
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Entity Type | Individual
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Provider Name | KUO JUNG GORDON LU MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 13285 MINNIEVILLE RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4018
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Country | US
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Telephone | 703-986-2400
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Fax |
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Provider Business Mailing Address
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Address Line | MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
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City | BOSTON
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State | MA
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Zip | 02114
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Country | US
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Telephone | 617-726-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101275179
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License Number State | VA
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