Healthcare Provider Details

I. General information

NPI: 1831565670
Provider Name (Legal Business Name): WU PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 TEMPLE CITY BLVD
TEMPLE CITY CA
91780-2113
US

IV. Provider business mailing address

5817 TEMPLE CITY BLVD
TEMPLE CITY CA
91780-2113
US

V. Phone/Fax

Practice location:
  • Phone: 626-285-1254
  • Fax:
Mailing address:
  • Phone: 626-285-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101672
License Number StateCA

VIII. Authorized Official

Name: DR. DEREK J WU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-285-1254