Healthcare Provider Details

I. General information

NPI: 1902486400
Provider Name (Legal Business Name): EMILY KAY WU MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 X ST STE 4202
SACRAMENTO CA
95817-2200
US

IV. Provider business mailing address

4236 DARDANELLES ST
SACRAMENTO CA
95834-7611
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5408
  • Fax:
Mailing address:
  • Phone: 203-650-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number196870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: