Provider Demographics
NPI:1063660660
Name:WU, ELLIN YING-CHUN (OD)
Entity Type:Individual
Prefix:
First Name:ELLIN
Middle Name:YING-CHUN
Last Name:WU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:YING-CHUN
Other - Middle Name:ELLIN
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1085 W EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1030
Mailing Address - Country:US
Mailing Address - Phone:408-524-5900
Mailing Address - Fax:408-524-5950
Practice Address - Street 1:1085 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1030
Practice Address - Country:US
Practice Address - Phone:408-524-5900
Practice Address - Fax:408-524-5950
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13544152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT13544Medicaid
CAAU373ZMedicare PIN