Provider Demographics
NPI:1407835119
Name:WU, SHI-QI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHI-QI
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2317 BRANDEN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1479
Mailing Address - Country:US
Mailing Address - Phone:323-662-4481
Mailing Address - Fax:323-662-4481
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MS# 43
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-671-7658
Practice Address - Fax:323-671-3647
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRM023207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics