Provider Demographics
NPI:1659316453
Name:TZUYING TAMMY WU MD INC
Entity Type:Organization
Organization Name:TZUYING TAMMY WU MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-551-1888
Mailing Address - Street 1:PO BOX 578958
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8958
Mailing Address - Country:US
Mailing Address - Phone:209-551-1888
Mailing Address - Fax:209-551-5662
Practice Address - Street 1:2336 SYLVAN AVE
Practice Address - Street 2:STE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9294
Practice Address - Country:US
Practice Address - Phone:209-551-1888
Practice Address - Fax:209-551-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83075174400000X
CAA82159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053308197OtherCALVIN LEE MD IND NPI
CA00A821590Medicaid
CA00A830750Medicaid
CA1699730077OtherINDIVIDUAL NPI
CA1053308197OtherCALVIN LEE MD IND NPI
CA00A821590Medicaid
CA00A830750Medicare ID - Type UnspecifiedTAMMY WU MD