Provider Demographics
NPI:1407419005
Name:WU, DANIEL JONATHAN (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JONATHAN
Last Name:WU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 E. IMPERIAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6735
Mailing Address - Country:US
Mailing Address - Phone:714-256-5074
Mailing Address - Fax:714-256-0770
Practice Address - Street 1:3230 E. IMPERIAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6735
Practice Address - Country:US
Practice Address - Phone:714-256-5074
Practice Address - Fax:714-256-0770
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist