Healthcare Provider Details

I. General information

NPI: 1447476064
Provider Name (Legal Business Name): THE INDUSTRIAL CLINIC AT MONTCLAIR, A MED CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18575 GALE AVE STE 198
CITY OF INDUSTRY CA
91748-1382
US

IV. Provider business mailing address

55 S RAYMOND AVE STE 105
ALHAMBRA CA
91801-7100
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-9004
  • Fax:
Mailing address:
  • Phone: 626-289-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA32175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA69486
License Number StateCA

VIII. Authorized Official

Name: DR. JACK X WU
Title or Position: PHYSICIAN
Credential: M.D
Phone: 626-289-9004