Provider Demographics
NPI:1881849115
Name:WU, VIVIAN F (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:F
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 1:1301 20TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2087
Mailing Address - Country:US
Mailing Address - Phone:310-829-7792
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2087
Practice Address - Country:US
Practice Address - Phone:310-829-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253955207Y00000X
CAC199477207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881849115OtherUNITED HEALTHCARE
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VA-004OtherTRICARE/CHAMPUS
VA495059OtherANTHEM BC/BS
VAPAROtherUSA MANAGED CARE
VA1881849115Medicaid
VA10110142OtherOPTIMA HEALTH
VA1881849115OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
NC1881849115Medicaid
VAPAROtherAETNA
VA1881849115OtherCOVENTRY NETWORK
VA10110142OtherOPTIMA HEALTH
NC1881849115Medicaid