Healthcare Provider Details

I. General information

NPI: 1447782438
Provider Name (Legal Business Name): SANG WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 S WESTERN AVE
LOS ANGELES CA
90062-1105
US

IV. Provider business mailing address

3881 S WESTERN AVE
LOS ANGELES CA
90062-1105
US

V. Phone/Fax

Practice location:
  • Phone: 760-576-7018
  • Fax:
Mailing address:
  • Phone: 760-576-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF99176
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF99176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: