Healthcare Provider Details

I. General information

NPI: 1235335878
Provider Name (Legal Business Name): CINDY J WU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 MARENGO ST
LOS ANGELES CA
90033-1319
US

IV. Provider business mailing address

600 W 9TH ST APT 1101
LOS ANGELES CA
90015-4334
US

V. Phone/Fax

Practice location:
  • Phone: 323-987-1040
  • Fax: 323-221-4528
Mailing address:
  • Phone: 626-226-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13183T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: