Healthcare Provider Details

I. General information

NPI: 1558380212
Provider Name (Legal Business Name): JUNE KAR-MING WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE SUITE 511A
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

PO BOX 27036
NEW YORK NY
10087-7036
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-3704
  • Fax: 212-305-9626
Mailing address:
  • Phone: 212-342-3704
  • Fax: 212-305-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number238908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: