Healthcare Provider Details

I. General information

NPI: 1891900890
Provider Name (Legal Business Name): IVAN T.J. WU AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E HUNTINGTON DR STE 121
ARCADIA CA
91006-3731
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-3138
  • Fax: 626-574-3195
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: