Healthcare Provider Details

I. General information

NPI: 1568921187
Provider Name (Legal Business Name): HO YAN WU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVE
TURLOCK CA
95382-2016
US

IV. Provider business mailing address

4102 AVENUE P
BROOKLYN NY
11234-3518
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-4200
  • Fax:
Mailing address:
  • Phone: 917-915-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: