Provider Demographics
NPI:1174824841
Name:WU, JUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KIM MING
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5451 LA PALMA AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623
Mailing Address - Country:US
Mailing Address - Phone:714-670-1340
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE STE 25
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623
Practice Address - Country:US
Practice Address - Phone:714-670-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11281207R00000X
LADO.000385207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00380163YH5NMedicaid
CA00380163YH5NMedicaid