Provider Demographics
NPI:1225342827
Name:WU, CHI YUNG (PH)
Entity Type:Individual
Prefix:
First Name:CHI YUNG
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N NEW PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1354
Mailing Address - Country:US
Mailing Address - Phone:732-905-4429
Mailing Address - Fax:732-905-9227
Practice Address - Street 1:1 N NEW PROSPECT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1354
Practice Address - Country:US
Practice Address - Phone:732-905-4429
Practice Address - Fax:732-905-9227
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03074600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist