MEDICARE: DR. TINA WU MD

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	A91185	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568663136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA WU MD

Provider Business Mailing Address
First Line	:	425 15TH ST UNIT 3142
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-7311
Country	:	US
Telephone Number	:	176-741-9049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 11TH ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6212
Country	:	US
Telephone Number	:	917-674-1904
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	11/16/2022

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