Provider Demographics
NPI:1255350138
Name:WU, ELSIE EH-SHE (MD)
Entity type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:EH-SHE
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 LOMBARDY ROAD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-744-1307
Mailing Address - Fax:
Practice Address - Street 1:1048 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4768
Practice Address - Country:US
Practice Address - Phone:626-289-1009
Practice Address - Fax:626-289-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80623207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G806230Medicaid
CA00G806230Medicaid