Provider Demographics
NPI:1306092424
Name:WU, GRACE T (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:T
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 N TUSTIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5900
Mailing Address - Country:US
Mailing Address - Phone:714-639-6162
Mailing Address - Fax:
Practice Address - Street 1:991 N TUSTIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5900
Practice Address - Country:US
Practice Address - Phone:714-639-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054643207R00000X
CA129362207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine