Healthcare Provider Details

I. General information

NPI: 1093145898
Provider Name (Legal Business Name): JIA WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 9TH ST STE 205
OAKLAND CA
94607-4478
US

IV. Provider business mailing address

212 9TH ST STE 205
OAKLAND CA
94607-4478
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-1118
  • Fax:
Mailing address:
  • Phone: 510-268-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number23536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: