Provider Demographics
NPI:1629353933
Name:WU, TIFFANY Y (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:Y
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4218
Mailing Address - Country:US
Mailing Address - Phone:714-560-4450
Mailing Address - Fax:714-560-4455
Practice Address - Street 1:1140 W LA VETA AVE STE 850
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4218
Practice Address - Country:US
Practice Address - Phone:714-560-4450
Practice Address - Fax:714-560-4455
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA118732208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery