Healthcare Provider Details

I. General information

NPI: 1861498107
Provider Name (Legal Business Name): WUU SHYONG WU M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BEVERLY BLVD STE 201
MONTEBELLO CA
90640-4315
US

IV. Provider business mailing address

101 E BEVERLY BLVD SUITE 201
MONTEBELLO CA
90640
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-5163
  • Fax: 323-724-6869
Mailing address:
  • Phone: 323-722-5163
  • Fax: 323-724-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. WUU SHYONG WU SR.
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 323-722-5163