Provider Demographics
NPI:1023529484
Name:WU, JOHN YA-LI (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:YA-LI
Last Name:WU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2788 TRAPPER SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-6261
Mailing Address - Country:US
Mailing Address - Phone:559-759-9224
Mailing Address - Fax:
Practice Address - Street 1:2788 TRAPPER SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-6261
Practice Address - Country:US
Practice Address - Phone:559-759-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant