Provider Demographics
NPI:1932119385
Name:WU, KESHENG (MD)
Entity Type:Individual
Prefix:
First Name:KESHENG
Middle Name:
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 1:9209 COLIMA RD STE 4500
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1823
Mailing Address - Country:US
Mailing Address - Phone:562-696-5088
Mailing Address - Fax:562-696-5227
Practice Address - Street 1:9209 COLIMA RD STE 4500
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1823
Practice Address - Country:US
Practice Address - Phone:562-696-5088
Practice Address - Fax:562-696-5227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667350Medicaid
CAH33397Medicare UPIN
CA00A667350Medicaid