Provider Demographics
NPI:1104888759
Name:SOUTHERN CALIFORNIA UROLOGY, INC.
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA UROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-598-0200
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-1868
Mailing Address - Country:US
Mailing Address - Phone:562-598-0200
Mailing Address - Fax:562-598-0222
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-598-0200
Practice Address - Fax:562-598-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73429Medicare UPIN
CAW19588AMedicare ID - Type UnspecifiedGROUP ID
CAW19588Medicare ID - Type UnspecifiedGROUP ID