Healthcare Provider Details

I. General information

NPI: 1265757108
Provider Name (Legal Business Name): LAUREN WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2010
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 INGLEWOOD BLVD STE 101
CULVER CITY CA
90230-5896
US

IV. Provider business mailing address

4700 INGLEWOOD BLVD STE 101
CULVER CITY CA
90230-5896
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-8636
  • Fax:
Mailing address:
  • Phone: 310-392-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA119748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: