=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457049728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAONENG WU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2023
-----------------------------------------------------
Last Update Date | 04/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6245 INKSTER RD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48135-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-506-7658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 162 WESLEY AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-506-7658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------