Provider Demographics
NPI:1760641534
Name:ROGER L. WU, O.D.
Entity Type:Organization
Organization Name:ROGER L. WU, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LI-CHUNG
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-810-3398
Mailing Address - Street 1:18575 GALE AVE
Mailing Address - Street 2:SUITE 168
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1340
Mailing Address - Country:US
Mailing Address - Phone:626-810-3398
Mailing Address - Fax:626-810-3342
Practice Address - Street 1:18575 GALE AVE
Practice Address - Street 2:SUITE 168
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1340
Practice Address - Country:US
Practice Address - Phone:626-810-3398
Practice Address - Fax:626-810-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10971T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98657Medicare UPIN