Healthcare Provider Details

I. General information

NPI: 1952861759
Provider Name (Legal Business Name): JESSE WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21214 NORTHWEST FWY
CYPRESS TX
77429-2105
US

IV. Provider business mailing address

21214 NORTHWEST FWY
CYPRESS TX
77429-2105
US

V. Phone/Fax

Practice location:
  • Phone: 321-697-1730
  • Fax:
Mailing address:
  • Phone: 321-697-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME152498
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT3722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: