Provider Demographics
NPI:1700375656
Name:WU, TIMOTHY YO (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:YO
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 1:9525 MONTE VISTA AVE # 105
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2231
Mailing Address - Country:US
Mailing Address - Phone:909-731-2715
Mailing Address - Fax:
Practice Address - Street 1:9525 MONTE VISTA AVE # 105
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2231
Practice Address - Country:US
Practice Address - Phone:909-731-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125071848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program