MEDICARE: XIAOYAN 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	2084P0800X	Psychiatry Physician	L1783	TX

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	:	1497813950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAOYAN WU M.D.

Provider Business Mailing Address
First Line	:	3840 HULEN ST
Second Line	:	HTN NORTH, CLIENT ACCOUNTING
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4395
Fax Number	:	817-569-4517

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:	HTN NORTH, CLIENT ACCOUNTING
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4395
Fax Number	:	817-569-4517

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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Directions to “ XIAOYAN WU M.D.” Practice Location

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