Healthcare Provider Details

I. General information

NPI: 1518592914
Provider Name (Legal Business Name): JESSE WOO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N ORANGE GROVE AVE STE 303
POMONA CA
91767-3028
US

IV. Provider business mailing address

1818 N ORANGE GROVE AVE STE 303
POMONA CA
91767-3028
US

V. Phone/Fax

Practice location:
  • Phone: 909-469-0890
  • Fax: 909-460-0890
Mailing address:
  • Phone: 909-469-0890
  • Fax: 909-469-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE WOO
Title or Position: OWNER
Credential: MD
Phone: 94-690-8909