Healthcare Provider Details

I. General information

NPI: 1083046924
Provider Name (Legal Business Name): MR. HARRY WU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 POST STREET COMMUNITY YOUTH CENTER
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

29 VERNON ST
SAN FRANCISCO CA
94132-3038
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 415-707-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberE2369182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: