Provider Demographics
NPI:1124117189
Name:WU, JAMES YONG ZHEN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:YONG ZHEN
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 ALEXANDER AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-0429
Mailing Address - Country:US
Mailing Address - Phone:631-265-8258
Mailing Address - Fax:631-265-8256
Practice Address - Street 1:112 ALEXANDER AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-0429
Practice Address - Country:US
Practice Address - Phone:631-265-8258
Practice Address - Fax:631-265-8256
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA229361171100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI04654Medicare UPIN
NY4409N2Medicare ID - Type Unspecified