Provider Demographics
NPI:1962695007
Name:WU, STEPHEN M (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:WU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 VIA MARISOL
Mailing Address - Street 2:APT. 220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5084
Mailing Address - Country:US
Mailing Address - Phone:323-343-1795
Mailing Address - Fax:
Practice Address - Street 1:WEST LOS ANGELES VA MEDICAL CENTER
Practice Address - Street 2:BUILDING 115 ROOM 107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:562-673-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical