Healthcare Provider Details

I. General information

NPI: 1629353933
Provider Name (Legal Business Name): TIFFANY Y WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 850
ORANGE CA
92868-4218
US

IV. Provider business mailing address

1140 W LA VETA AVE STE 850
ORANGE CA
92868-4218
US

V. Phone/Fax

Practice location:
  • Phone: 714-560-4450
  • Fax: 714-560-4455
Mailing address:
  • Phone: 714-560-4450
  • Fax: 714-560-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA118732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: