Provider Demographics
NPI:1336228253
Name:WU, SHANG CHENG (MD)
Entity type:Individual
Prefix:
First Name:SHANG
Middle Name:CHENG
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3141 S HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6304
Mailing Address - Country:US
Mailing Address - Phone:626-937-6663
Mailing Address - Fax:626-937-6653
Practice Address - Street 1:3141 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6304
Practice Address - Country:US
Practice Address - Phone:626-937-6663
Practice Address - Fax:626-937-6653
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79748207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A797480Medicaid
CA00A797480OtherBLUE SHIELD OF CALIFORNIA
CAH05018Medicare UPIN
CAH05018Medicare ID - Type Unspecified