Provider Demographics
NPI:1659329993
Name:WU, SAMUEL WENDONG (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WENDONG
Last Name:WU
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:WENDONG
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,PHD
Mailing Address - Street 1:7880 WREN AVE STE D143
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7802
Mailing Address - Country:US
Mailing Address - Phone:408-846-1800
Mailing Address - Fax:
Practice Address - Street 1:7880 WREN AVE STE D143
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7802
Practice Address - Country:US
Practice Address - Phone:408-846-1800
Practice Address - Fax:408-846-1995
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA740740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770603976OtherTIN
CA00A740740Medicare ID - Type Unspecified
CA770603976OtherTIN
CAP00061230Medicare ID - Type UnspecifiedRAILROAD MEDICARE