Healthcare Provider Details

I. General information

NPI: 1558711812
Provider Name (Legal Business Name): HAO WU D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 DEL AMO BLVD
LAKEWOOD CA
90712-2760
US

IV. Provider business mailing address

904 REDLEN AVE
WHITTIER CA
90601-1134
US

V. Phone/Fax

Practice location:
  • Phone: 562-866-4046
  • Fax:
Mailing address:
  • Phone: 626-715-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006987
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: