Provider Demographics
NPI:1609954726
Name:WU, HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
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 1:520 N PROSPECT AVE
Mailing Address - Street 2:#203
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-318-5509
Mailing Address - Fax:310-372-9188
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:#203
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-318-5509
Practice Address - Fax:310-372-9188
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G549750OtherMEDICAL PROVIDER #
00G549750OtherMEDICAL PROVIDER #
E51767Medicare ID - Type Unspecified