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General NPI Number Information
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NPI Number | 1417078387
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Entity Type | Organization
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Legal Business Name | DIANNE E WU M D S C A PROFESSIONAL
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 1048 S GARFIELD AVE #300
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City | ALHAMBRA
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State | CA
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Zip | 91801-4768
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Country | US
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Telephone | 626-458-7564
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Fax |
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Provider Business Mailing Address
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Address Line | 1048 S GARFIELD AVE #300
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City | ALHAMBRA
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State | CA
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Zip | 91801-4768
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Country | US
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Telephone | 626-458-7564
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANNE E WU
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Credential | M.D.
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Telephone | 626-458-7564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G79383
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License Number State | CA
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