Provider Demographics
NPI:1194713313
Name:WU, HSIAO-CHI DAVID (MD)
Entity type:Individual
Prefix:
First Name:HSIAO-CHI
Middle Name:DAVID
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:4920 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-3653
Practice Address - Country:US
Practice Address - Phone:503-215-3300
Practice Address - Fax:503-215-3350
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38200207Q00000X
ORMD26926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81180047Medicaid
OR026492Medicaid
CO81180047Medicaid
H43863Medicare UPIN
ORR136343Medicare PIN