Healthcare Provider Details

I. General information

NPI: 1518435239
Provider Name (Legal Business Name): XIAOBIN WU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 JURUPA ST STE 110
ONTARIO CA
91761-1429
US

IV. Provider business mailing address

4295 JURUPA ST STE 110
ONTARIO CA
91761-1429
US

V. Phone/Fax

Practice location:
  • Phone: 909-972-8120
  • Fax:
Mailing address:
  • Phone: 909-972-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: