Provider Demographics
NPI:1700188380
Name:HENRY WU, M.D. INC.
Entity Type:Organization
Organization Name:HENRY WU, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:YUEN-TSUN
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-318-5509
Mailing Address - Street 1:520 N. PROSPECT AVE.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3042
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:SUITE 203
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3042
Practice Address - Country:US
Practice Address - Phone:310-318-5509
Practice Address - Fax:310-372-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE51767Medicare UPIN