Healthcare Provider Details

I. General information

NPI: 1942694575
Provider Name (Legal Business Name): DAVID D WU MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 CRENSHAW BLVD
TORRANCE CA
90501-2433
US

IV. Provider business mailing address

1408 CRENSHAW BLVD
TORRANCE CA
90501-2433
US

V. Phone/Fax

Practice location:
  • Phone: 424-256-7356
  • Fax: 424-253-0925
Mailing address:
  • Phone: 310-507-9171
  • Fax: 310-507-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA110885
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA110885
License Number StateCA

VIII. Authorized Official

Name: DAVID D WU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-299-8288