Provider Demographics
NPI:1265538912
Name:WU, ALLAN YANG (MD, CTBS)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:YANG
Last Name:WU
Suffix:
Gender:M
Credentials:MD, CTBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W COLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-9722
Mailing Address - Country:US
Mailing Address - Phone:760-357-2020
Mailing Address - Fax:760-357-1056
Practice Address - Street 1:233 W COLE BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9722
Practice Address - Country:US
Practice Address - Phone:760-344-9951
Practice Address - Fax:760-344-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67036207V00000X, 207VE0102X
IN01057730207VE0102X, 207VG0400X
IN01057720207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11170957OtherCAQH NUMBER
IN200450910AMedicaid
IN11170957OtherCAQH NUMBER