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General NPI Number Information
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NPI Number | 1619474616
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Entity Type | Individual
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Provider Name | MARK WU MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 444 S SAN VICENTE BLVD STE 603
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City | LOS ANGELES
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State | CA
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Zip | 90048-4178
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Country | US
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Telephone | 310-423-4566
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Fax | 424-314-8799
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Provider Business Mailing Address
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Address Line | 4140 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5513
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Country | US
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Telephone |
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 100910
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 74076
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A196874
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License Number State | CA
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