Healthcare Provider Details

I. General information

NPI: 1750523478
Provider Name (Legal Business Name): MICHAEL WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

IV. Provider business mailing address

3967 LOUISIANA ST
SAN DIEGO CA
92104-2777
US

V. Phone/Fax

Practice location:
  • Phone: 213-669-6453
  • Fax: 877-883-6503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA112396
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD151030
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: