Healthcare Provider Details

I. General information

NPI: 1083895437
Provider Name (Legal Business Name): WUU JAU PERNG, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 CENTER RD
HINCKLEY OH
44233-9561
US

IV. Provider business mailing address

PO BOX 337
HINCKLEY OH
44233-0337
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-4811
  • Fax: 330-220-7283
Mailing address:
  • Phone: 330-225-4811
  • Fax: 330-220-7283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WUU JAU PERNG
Title or Position: OWNER
Credential: M.D.
Phone: 330-225-4811