Provider Demographics
NPI:1669706453
Name:WU, PEI-CHI (DO)
Entity type:Individual
Prefix:DR
First Name:PEI-CHI
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S BREA CANYON RD STE A1
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4012
Mailing Address - Country:US
Mailing Address - Phone:909-861-6853
Mailing Address - Fax:909-963-1796
Practice Address - Street 1:2020 S BREA CANYON RD STE A1
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4012
Practice Address - Country:US
Practice Address - Phone:909-861-6853
Practice Address - Fax:909-963-1796
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU814ZMedicare PIN