Provider Demographics
NPI:1164616223
Name:WU, DEREK J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:J
Last Name:WU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:#221
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-431-6548
Mailing Address - Fax:562-761-2086
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:#221
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-431-6548
Practice Address - Fax:562-761-2086
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101672OtherCA MED LIC
CAZZZ54049YOtherBS/TRIWEST
CA1164616223Medicaid
CA1164616223Medicaid
CAAS743AMedicare PIN
CAAS772ZMedicare PIN