Provider Demographics
NPI:1972526457
Name:WU, SIDNEY S (MD)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:S
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 1:8041 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7034
Mailing Address - Country:US
Mailing Address - Phone:888-499-9303
Mailing Address - Fax:714-842-4359
Practice Address - Street 1:8041 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7034
Practice Address - Country:US
Practice Address - Phone:888-499-9303
Practice Address - Fax:714-842-4359
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78985208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A789850Medicaid
CA00A789850Medicaid
CA00A789850Medicaid