Healthcare Provider Details

I. General information

NPI: 1275745515
Provider Name (Legal Business Name): SHANG WU M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 S HACIENDA BLVD
HACIENDA HEIGHTS CA
91745-6304
US

IV. Provider business mailing address

3141 S HACIENDA BLVD
HACIENDA HEIGHTS CA
91745-6304
US

V. Phone/Fax

Practice location:
  • Phone: 626-937-6663
  • Fax: 626-937-6653
Mailing address:
  • Phone: 626-937-6663
  • Fax: 626-937-6653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANG CHENG WU
Title or Position: CEO
Credential: M.D.
Phone: 626-937-6663