MEDICARE: CHING HA JENNY 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	174400000X	Specialist
2	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1770130163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHING HA JENNY WU

Provider Business Mailing Address
First Line	:	6811 15TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-6310
Country	:	US
Telephone Number	:	646-812-8374
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5028
Country	:	US
Telephone Number	:	646-812-8374
Fax Number	:

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	05/17/2022

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