Healthcare Provider Details

I. General information

NPI: 1629546379
Provider Name (Legal Business Name): CHANG-I WU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CLARENDON BLVD APT 700
ARLINGTON VA
22209-4315
US

IV. Provider business mailing address

1530 CLARENDON BLVD APT 700
ARLINGTON VA
22209-4315
US

V. Phone/Fax

Practice location:
  • Phone: 585-329-3397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number261717
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number261717
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: