Healthcare Provider Details

I. General information

NPI: 1134890874
Provider Name (Legal Business Name): MAN CHUN TONY WU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

IV. Provider business mailing address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5704
  • Fax:
Mailing address:
  • Phone: 510-567-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95223832
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WX1100X
TaxonomyOphthalmic Registered Nurse
License Number95223832
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95223832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: