Provider Demographics
NPI:1962167635
Name:WU, KUAN HSUAN
Entity type:Individual
Prefix:
First Name:KUAN HSUAN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 BAYFRONT BLVD UNIT 336
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1663
Mailing Address - Country:US
Mailing Address - Phone:415-602-3394
Mailing Address - Fax:
Practice Address - Street 1:201 W NAPA ST # 35
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6643
Practice Address - Country:US
Practice Address - Phone:707-938-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist