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General NPI Number Information
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NPI Number | 1609352665
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Entity Type | Organization
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Legal Business Name | WU LEE QUOCK MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 1044 TARAVAL ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2423
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Country | US
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Telephone | 415-216-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 TARAVAL ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2423
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Country | US
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Telephone | 415-216-0088
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DERRINA WU
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Credential | MD
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Telephone | 415-216-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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