Healthcare Provider Details

I. General information

NPI: 1760602569
Provider Name (Legal Business Name): DIANA H. WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE CH10F
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 SW BOND AVE CH10F
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-3744
  • Fax: 503-418-3708
Mailing address:
  • Phone: 503-418-3744
  • Fax: 503-418-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-091901
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301084032
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD154589
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD154589
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: