Provider Demographics
NPI:1467482737
Name:WU, JOANNA (DPM)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S HACIENDA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2200
Mailing Address - Country:US
Mailing Address - Phone:626-961-1882
Mailing Address - Fax:626-968-7599
Practice Address - Street 1:1201 S HACIENDA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-2200
Practice Address - Country:US
Practice Address - Phone:626-961-1882
Practice Address - Fax:626-968-7599
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4448213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4448Medicare PIN
CAU95449Medicare UPIN
CA5263220001Medicare NSC