Individual
DEREK WU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
450 CLARKSON AVE # 1262, SUNY DOWNSTATE MEDICAL CENTER, BROOKLYN, NY 11203-2012
(718) 270-8867
Mailing address
PHR GROUP PROVIDER ENROLLMENT UNIT, 393 E WALNUT ST GPEU FL 3SCPMG, PASADENA, CA 91188-0001
(877) 608-0044
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036150776
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2015
Last updated
12/03/2021
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