Provider Demographics
NPI:1902876725
Name:WU, STANLEY LONGJYI (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:LONGJYI
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 1:1504 TAUB LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:713-873-2626
Mailing Address - Fax:713-873-2672
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-2626
Practice Address - Fax:713-873-2672
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02380363AM0700X
NY253504207P00000X
390200000X
TXN5492207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88N060OtherBCBS PROVIDER NUMBER
TX970017934OtherRAILROAD MEDICARE PROV #
TX86N868Medicaid
TXTXB109409Medicare PIN
TX88N060OtherBCBS PROVIDER NUMBER