Healthcare Provider Details

I. General information

NPI: 1982647939
Provider Name (Legal Business Name): JIMMY WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 HARBOR BLVD
GARDEN GROVE CA
92840-5800
US

IV. Provider business mailing address

12751 HARBOR BLVD
GARDEN GROVE CA
92840-5800
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-7852
  • Fax:
Mailing address:
  • Phone: 714-636-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA-49571
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA-49571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: