Provider Demographics
NPI:1417963661
Name:WU, TAI HING (MD)
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:HING
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 1:415 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3728
Mailing Address - Country:US
Mailing Address - Phone:626-943-9240
Mailing Address - Fax:626-943-9242
Practice Address - Street 1:415 W VALLEY BLVD
Practice Address - Street 2:C
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3728
Practice Address - Country:US
Practice Address - Phone:626-943-9240
Practice Address - Fax:626-943-9242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A466920Medicaid
CA00A466920Medicaid
CAF02336Medicare UPIN