Provider Demographics
NPI:1124195623
Name:WU, RAYMOND HSIUNG HSIANG (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HSIUNG HSIANG
Last Name:WU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2046
Mailing Address - Country:US
Mailing Address - Phone:626-967-3794
Mailing Address - Fax:626-967-8404
Practice Address - Street 1:911 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2046
Practice Address - Country:US
Practice Address - Phone:626-967-3794
Practice Address - Fax:626-967-8404
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7098T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070980Medicaid
CAU35829Medicare UPIN
CASD0070980Medicaid