Healthcare Provider Details

I. General information

NPI: 1164616223
Provider Name (Legal Business Name): DEREK J. WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 KATELLA AVE #221
LOS ALAMITOS CA
90720-3338
US

IV. Provider business mailing address

3801 KATELLA AVE #221
LOS ALAMITOS CA
90720-3338
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-6548
  • Fax: 562-761-2086
Mailing address:
  • Phone: 562-431-6548
  • Fax: 562-761-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: