Healthcare Provider Details

I. General information

NPI: 1720070113
Provider Name (Legal Business Name): JAMES C WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE STE 411
DALY CITY CA
94015-2228
US

IV. Provider business mailing address

1800 SULLIVAN AVE STE 411
DALY CITY CA
94015-2228
US

V. Phone/Fax

Practice location:
  • Phone: 650-994-3223
  • Fax:
Mailing address:
  • Phone: 650-994-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA91181
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number218786-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: