Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A129892 | CA |
Y | 2080P0204X | Pediatric Emergency Doctor | A129892 | CA |
NPI | 1265799803 |
---|---|
Provider Name | Winston S. Wu |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 21/05/2019 |