Healthcare Provider Details

I. General information

NPI: 1063403426
Provider Name (Legal Business Name): WUU-SHUNG CHUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W LORAIN ST STE A
OBERLIN OH
44074-1096
US

IV. Provider business mailing address

224 W LORAIN ST STE A
OBERLIN OH
44074-1096
US

V. Phone/Fax

Practice location:
  • Phone: 440-774-5248
  • Fax: 440-774-6006
Mailing address:
  • Phone: 440-774-5248
  • Fax: 440-774-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35100090C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: