MEDICARE: JENG REN 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	207Q00000X	Family Medicine Physician	C39737	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487766069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENG REN WU M.D.

Provider Business Mailing Address
First Line	:	355 E 21ST STREET
Second Line	:	SUITE G
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3808
Country	:	US
Telephone Number	:	909-886-8618
Fax Number	:	909-886-3935

Provider Business Practice Location Address
First Line	:	355 E 21ST ST
Second Line	:	SUITE G
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-886-8618
Fax Number	:	909-886-3935

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ JENG REN WU M.D.” Practice Location

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