Provider Demographics
NPI:1205065927
Name:WU, GINA (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KLEE LN
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-2025
Mailing Address - Country:US
Mailing Address - Phone:602-406-3153
Mailing Address - Fax:
Practice Address - Street 1:11 KLEE LN
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-2025
Practice Address - Country:US
Practice Address - Phone:480-231-8067
Practice Address - Fax:480-231-8067
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006429207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1546OtherTRAINER PERMIT