Healthcare Provider Details

I. General information

NPI: 1164749552
Provider Name (Legal Business Name): YUFENG KEVIN WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E DAY RD STE 200
MISHAWAKA IN
46545-3455
US

IV. Provider business mailing address

301 E DAY RD STE 200
MISHAWAKA IN
46545-3455
US

V. Phone/Fax

Practice location:
  • Phone: 574-204-7252
  • Fax: 574-968-0468
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01074454A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01074454A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: