Provider Demographics
NPI:1174616684
Name:WU, MIN- SHUNG (MD)
Entity type:Individual
Prefix:
First Name:MIN- SHUNG
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:PO BOX 2691
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2691
Mailing Address - Country:US
Mailing Address - Phone:559-741-9889
Mailing Address - Fax:559-741-9338
Practice Address - Street 1:510 W OAK AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6039
Practice Address - Country:US
Practice Address - Phone:559-741-9889
Practice Address - Fax:559-741-9338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51671207R00000X, 207RE0101X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A516711Medicaid
CA00A516711Medicaid
F94795Medicare UPIN