Healthcare Provider Details

I. General information

NPI: 1710769252
Provider Name (Legal Business Name): JULIA WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15576 BROOKHURST ST STE B
WESTMINSTER CA
92683-7586
US

IV. Provider business mailing address

15576 BROOKHURST ST STE B
WESTMINSTER CA
92683-7586
US

V. Phone/Fax

Practice location:
  • Phone: 657-206-8003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: