Basic Information
Provider Information
NPI: 1629129812
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WU
FirstName: ANDREW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 DISTEL CIR
Address2:  
City: LOS ALTOS
State: CA
PostalCode: 940221408
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1661 SOQUEL DR STE D
Address2:  
City: SANTA CRUZ
State: CA
PostalCode: 950651709
CountryCode: US
TelephoneNumber: 8314586925
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/15/2007
LastUpdateDate: 02/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA95606CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XA95606CAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home