Provider Demographics
NPI:1457512584
Name:WU, JACK JYH-PERNG (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:JYH-PERNG
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 PLATT AVE
Mailing Address - Street 2:#726
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3218
Mailing Address - Country:US
Mailing Address - Phone:818-220-7853
Mailing Address - Fax:
Practice Address - Street 1:5000 NORTH PARKWAY CALABASAS
Practice Address - Street 2:STE 103
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-220-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA932282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry