Healthcare Provider Details

I. General information

NPI: 1235354150
Provider Name (Legal Business Name): KENG I JAMES WU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N CHERRY ST
TULARE CA
93274-2251
US

IV. Provider business mailing address

3917 W ORIOLE CT
VISALIA CA
93291-8078
US

V. Phone/Fax

Practice location:
  • Phone: 559-684-8703
  • Fax: 559-685-2405
Mailing address:
  • Phone: 626-414-7459
  • Fax: 626-414-7459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: