Healthcare Provider Details

I. General information

NPI: 1689900599
Provider Name (Legal Business Name): BRIAN PAK WU PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 N BROADWAY
LOS ANGELES CA
90012-2801
US

IV. Provider business mailing address

655 N BROADWAY
LOS ANGELES CA
90012-2801
US

V. Phone/Fax

Practice location:
  • Phone: 213-617-7888
  • Fax: 213-617-7241
Mailing address:
  • Phone: 213-617-7888
  • Fax: 213-617-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: