Healthcare Provider Details

I. General information

NPI: 1225458573
Provider Name (Legal Business Name): MICHAEL WU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST STREET ATTN ANESTHESIA DEPARTMENT
OAKLAND CA
94602
US

IV. Provider business mailing address

1411 E 31ST STREET ATTN ANESTHESIA DEPARTMENT
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4800
  • Fax:
Mailing address:
  • Phone: 510-437-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA138737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: