MEDICARE: DR. SHI-QI WU M.D.

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	207SC0300X	Clinical Cytogenetics Physician	DRM023	CA

General Provider Information

NPI Number	:	1407835119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHI-QI WU M.D.

Provider Business Mailing Address
First Line	:	2317 BRANDEN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1479
Country	:	US
Telephone Number	:	323-662-4481
Fax Number	:	323-662-4481

Provider Business Practice Location Address
First Line	:	4650 W SUNSET BLVD
Second Line	:	MS# 43
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6062
Country	:	US
Telephone Number	:	323-671-7658
Fax Number	:	323-671-3647

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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