MEDICARE: TEENIE WU

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	183500000X	Pharmacist	91985	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1033886163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEENIE WU

Provider Business Mailing Address
First Line	:	12640 BELINDA CT
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-5368
Country	:	US
Telephone Number	:	310-918-8113
Fax Number	:

Provider Business Practice Location Address
First Line	:	6041 CADILLAC AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1702
Country	:	US
Telephone Number	:	310-918-8113
Fax Number	:

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	02/10/2026

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Directions to “ TEENIE WU ” Practice Location

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