Provider Demographics
NPI:1861498107
Name:WUU SHYONG WU M.D.
Entity Type:Organization
Organization Name:WUU SHYONG WU M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WUU
Authorized Official - Middle Name:SHYONG
Authorized Official - Last Name:WU
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:323-722-5163
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-722-5163
Mailing Address - Fax:323-724-6869
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:STE 201
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4315
Practice Address - Country:US
Practice Address - Phone:323-722-5163
Practice Address - Fax:323-724-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A376870Medicaid
CAD83904Medicare UPIN
CA00A376870Medicaid