Healthcare Provider Details

I. General information

NPI: 1376928077
Provider Name (Legal Business Name): WU PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 562-431-6548
  • Fax: 714-761-2086
Mailing address:
  • Phone: 562-431-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DEREK J WU
Title or Position: OWNER
Credential: MD
Phone: 562-431-6548