Provider Demographics
NPI:1144256009
Name:WU, AGNES Y (MD)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:Y
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 C ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3616
Mailing Address - Country:US
Mailing Address - Phone:661-325-2694
Mailing Address - Fax:661-327-0816
Practice Address - Street 1:1700 C ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3616
Practice Address - Country:US
Practice Address - Phone:661-325-2640
Practice Address - Fax:661-327-0816
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50093207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A500930Medicaid
CA00A500931Medicare PIN
CA00A500930Medicaid