Provider Information for 1790208494
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FANG-YI WU
Sex: Female
NPI: 1790208494
Last Updated: 2021-07-15
Certification Date: 2021-07-15
Certification Date: 2021-07-15
Details
| Name | Value | ||||||||||||
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| NPI | 1790208494 | ||||||||||||
| Enumeration Date | 2017-07-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 513 COBB CT LA PUENTE, CA 91746-1967 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 9353 VALLEY BLVD ROSEMEAD, CA 91770-1934 United States Phone: 323-492-6072 | Fax: | ||||||||||||
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