Provider Demographics
NPI:1154381218
Name:WU, JIANWEN (MD)
Entity type:Individual
Prefix:
First Name:JIANWEN
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 2106
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-2106
Mailing Address - Country:US
Mailing Address - Phone:480-629-5113
Mailing Address - Fax:480-821-2309
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:STE 106
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-629-5113
Practice Address - Fax:480-821-2309
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ074612Medicaid
AZZ109039Medicare PIN
AZZ109040Medicare PIN
H73666Medicare UPIN