Provider Demographics
NPI:1477721207
Name:WU, SIMON D (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:D
Last Name:WU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8851 CENTER DRIVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3058
Mailing Address - Country:US
Mailing Address - Phone:619-828-1000
Mailing Address - Fax:619-828-1001
Practice Address - Street 1:8851 CENTER DRIVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3058
Practice Address - Country:US
Practice Address - Phone:619-828-1000
Practice Address - Fax:619-828-1001
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2021-11-17
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Provider Licenses
StateLicense IDTaxonomies
CAA87300208800000X
IL036 120136208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology