Healthcare Provider Details

I. General information

NPI: 1336451475
Provider Name (Legal Business Name): YAO HUI WU PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

15230 SHADYBEND DR #9
HACIENDA HEIGHTS CA
91745-2159
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4000
  • Fax:
Mailing address:
  • Phone: 949-202-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: