Provider Demographics
NPI:1326005794
Name:WU, JUNG-YI (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNG-YI
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 1:54 CLARKE CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6759
Mailing Address - Country:US
Mailing Address - Phone:609-924-4042
Mailing Address - Fax:
Practice Address - Street 1:285 DAVIDSON AVE
Practice Address - Street 2:ACNJ - THIRD FLOOR
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4153
Practice Address - Country:US
Practice Address - Phone:732-271-1400
Practice Address - Fax:732-271-3543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02596100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ357600Medicaid
NJ357600Medicaid
NJ441380Medicare ID - Type UnspecifiedPROVIDER#