Healthcare Provider Details

I. General information

NPI: 1679409395
Provider Name (Legal Business Name): MR. GUOJI WU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13616 35TH AVE APT 3A
FLUSHING NY
11354-2905
US

IV. Provider business mailing address

13616 35TH AVE APT 3A
FLUSHING NY
11354-2905
US

V. Phone/Fax

Practice location:
  • Phone: 347-557-5365
  • Fax:
Mailing address:
  • Phone: 347-557-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number951225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: