Provider Demographics
NPI:1710374251
Name:TU, KUO-WEI DAVID (OTC)
Entity Type:Individual
Prefix:MR
First Name:KUO-WEI
Middle Name:DAVID
Last Name:TU
Suffix:
Gender:M
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:400 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6814
Mailing Address - Country:US
Mailing Address - Phone:310-546-3461
Mailing Address - Fax:310-546-6481
Practice Address - Street 1:400 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:310-546-3461
Practice Address - Fax:310-546-6481
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-0618246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist