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General NPI Number Information
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NPI Number | 1336408707
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Entity Type | Individual
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Provider Name | KENNY KA-SHING WU M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST GME OFFICE CSP 21005
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 9105 ARDENDALE AVE
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City | SAN GABRIEL
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State | CA
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Zip | 91775-2003
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Country | US
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Telephone | 626-382-9375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A127627
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License Number State | CA
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