Healthcare Provider Details

I. General information

NPI: 1285605014
Provider Name (Legal Business Name): JIM YING-JIAN WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIM YING-JIAN WU MD

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58457 29 PALMS HWY STE 200
YUCCA VALLEY CA
92284-5879
US

IV. Provider business mailing address

58457 29 PALMS HWY STE 200
YUCCA VALLEY CA
92284-5879
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-1813
  • Fax: 760-369-7331
Mailing address:
  • Phone: 760-228-1813
  • Fax: 760-369-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-15596
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC51365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: