Provider Demographics
NPI:1326042136
Name:WU, HEIDI H (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:H
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2227
Mailing Address - Country:US
Mailing Address - Phone:310-659-9950
Mailing Address - Fax:310-659-9957
Practice Address - Street 1:50 N. LA CIENEGA BLVD.
Practice Address - Street 2:STE 320
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-659-9950
Practice Address - Fax:310-659-9957
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617860Medicaid
CA95-4867055OtherBLUE CROSS
CA00A617860OtherBLUE SHIELD
CAWA61786DMedicare PIN
CA00A617860OtherBLUE SHIELD
CAA61786Medicare PIN