Provider Demographics
NPI:1720547110
Name:WU, WING (NP)
Entity Type:Individual
Prefix:
First Name:WING
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WING
Other - Middle Name:SAN
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5915 HOLLIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2066
Mailing Address - Country:US
Mailing Address - Phone:510-686-3621
Mailing Address - Fax:
Practice Address - Street 1:5915 HOLLIS ST STE B
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2066
Practice Address - Country:US
Practice Address - Phone:510-686-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner