Provider Demographics
NPI:1275680829
Name:WU, CHIEN-KO (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIEN-KO
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 N TUSTIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5900
Mailing Address - Country:US
Mailing Address - Phone:714-639-6162
Mailing Address - Fax:714-639-5835
Practice Address - Street 1:991 N TUSTIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5900
Practice Address - Country:US
Practice Address - Phone:714-639-6162
Practice Address - Fax:714-639-5835
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A384910Medicaid
CAA38491OtherPIN
CA00A384910Medicaid
CAA88463Medicare ID - Type Unspecified