Provider Demographics
NPI:1366406381
Name:WU, DAISY (DPM)
Entity type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:DPM
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 80362
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0362
Mailing Address - Country:US
Mailing Address - Phone:951-751-9096
Mailing Address - Fax:951-848-9163
Practice Address - Street 1:4646 BROCKTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0103
Practice Address - Country:US
Practice Address - Phone:951-751-9096
Practice Address - Fax:951-848-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4404213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E44040Medicaid
P00317457OtherRAILROAD MEDICARE
CAE44040OtherCA LICENSE
CAU91569OtherUPIN
CAE44040OtherCA LICENSE