Healthcare Provider Details

I. General information

NPI: 1124348248
Provider Name (Legal Business Name): JASON MINGJI WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N STE 200
ROBBINSDALE MN
55422
US

IV. Provider business mailing address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2900
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-5400
  • Fax: 763-581-5401
Mailing address:
  • Phone: 763-581-5400
  • Fax: 763-581-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301096736
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number60966
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: