Provider Demographics
NPI:1669462768
Name:WU, JENNIFER Z (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:Z
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 233
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-9310
Mailing Address - Fax:937-832-8613
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 233
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-832-9310
Practice Address - Fax:937-832-8613
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2588016Medicaid
OHI42165Medicare UPIN
OH4169533Medicare PIN
OH2588016Medicaid