Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A111908 | CA |
NPI | 1063747152 |
---|---|
Provider Name | Dr. Alex Kyle Wu |
First Address | Oakland, CA 94612-3466 |
Second Address | South San Francisco, CA 94080-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 15/12/2021 |