MEDICARE: DR. TINA WU M.D., M.B.A.

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	207P00000X	Emergency Medicine Physician	266395	NY
2	208D00000X	General Practice Physician	188846	CA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356667117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA WU M.D., M.B.A.

Provider Business Mailing Address
First Line	:	4210 VIA MARINA APT 442
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-7545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	212-263-5506
Fax Number	:

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	04/27/2026

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