Healthcare Provider Details

I. General information

NPI: 1750463014
Provider Name (Legal Business Name): WHITTIER PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8522 SOUTH PAINTER AVENUE
WHITTIER CA
90602
US

IV. Provider business mailing address

8522 SOUTH PAINTER AVENUE
WHITTIER CA
90602
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6266
  • Fax: 562-945-4530
Mailing address:
  • Phone: 562-698-6266
  • Fax: 562-945-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG69605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA16394
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA38969
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA69656
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA47899
License Number StateCA

VIII. Authorized Official

Name: YU-FEI WU
Title or Position: MANAGER
Credential: MD
Phone: 562-698-6266