Healthcare Provider Details

I. General information

NPI: 1578539870
Provider Name (Legal Business Name): HSI-YANG WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST STE 175
PROVIDENCE RI
02905-3246
US

IV. Provider business mailing address

195 COLLYER ST STE 201
PROVIDENCE RI
02904-1869
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-0710
  • Fax: 401-421-0796
Mailing address:
  • Phone: 401-421-0710
  • Fax: 401-421-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD068048L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG79697
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberG79697
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD16872
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: