Provider Demographics
NPI:1699138511
Name:WU, VANESSA YU-WEN (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:YU-WEN
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 1:1640 NEWPORT BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7725
Mailing Address - Country:US
Mailing Address - Phone:949-386-5101
Mailing Address - Fax:833-623-5065
Practice Address - Street 1:1640 NEWPORT BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7725
Practice Address - Country:US
Practice Address - Phone:949-386-5101
Practice Address - Fax:833-623-5063
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA152955207Q00000X, 208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program