Provider Demographics
NPI:1982320172
Name:WU, ALFRED H
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:H
Last Name:WU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORPORATE PARK STE 170
Mailing Address - Street 2:STE 170
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5162
Mailing Address - Country:US
Mailing Address - Phone:855-427-2778
Mailing Address - Fax:949-900-2175
Practice Address - Street 1:3 CORPORATE PARK STE 170
Practice Address - Street 2:STE 170
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5162
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:949-900-2175
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022128363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health