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1861083503 NPI number — JONATHAN WU PT, DPT

NPI Number: 1861083503
Health Care Provider/Practitioner: JONATHAN WU PT, DPT

Information about “1861083503” NPI (JONATHAN WU PT, DPT) exists in 1861083503 in HTML format HTML  |  1861083503 in plain Text format TXT  |  1861083503 in PDF (Portable Document Format) PDF  |  1861083503 in an XML format XML  formats.

NPI Number : 1861083503 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861083503",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WU",
    "FirstName": "JONATHAN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "20823 STEVENS CREEK BLVD",
    "SecondLineMailingAddress": "STE 200",
    "MailingAddressCityName": "CUPERTINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95014-2112",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-828-1894",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "21863 VALLEJO ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAYWARD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94541-2523",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-750-1245",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/26/2021",
    "LastUpdateDate": "06/01/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "299660",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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