Provider Demographics
NPI:1417921412
Name:WU, WENWEI (MD)
Entity Type:Individual
Prefix:
First Name:WENWEI
Middle Name:
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:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-877-8600
Mailing Address - Fax:702-242-7944
Practice Address - Street 1:2716 N TENAYA WAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-877-8600
Practice Address - Fax:702-242-7944
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00342151OtherMEDICARE RAILROAD
NV100503644Medicaid
NV100503644Medicaid
NVV39622Medicare PIN
NV39622Medicare PIN