Provider Demographics
NPI:1497503247
Name:WU YI, KIN WA
Entity type:Individual
Prefix:
First Name:KIN WA
Middle Name:
Last Name:WU YI
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 1:7712 VANGUARD CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3011
Mailing Address - Country:US
Mailing Address - Phone:415-770-5212
Mailing Address - Fax:
Practice Address - Street 1:13701 HAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-3509
Practice Address - Country:US
Practice Address - Phone:415-770-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician