MEDICARE: WEI GUANG WU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	538950626	NY

General Provider Information

NPI Number	:	1104350016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WEI GUANG WU

Provider Business Mailing Address
First Line	:	6602 11TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219
Country	:	US
Telephone Number	:	718-238-3869
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 11TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5901
Country	:	US
Telephone Number	:	718-238-3869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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Directions to “ WEI GUANG WU ” Practice Location

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