Provider Demographics
NPI:1538194451
Name:WU, CHIA-DER (MD)
Entity type:Individual
Prefix:
First Name:CHIA-DER
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHIA-DER
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:133-47 SANFORD AVE
Mailing Address - Street 2:STE 2B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-762-2113
Mailing Address - Fax:718-961-8665
Practice Address - Street 1:133-47 SANFORD AVE
Practice Address - Street 2:STE 2B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-762-2113
Practice Address - Fax:718-961-8665
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152365207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00741277Medicaid
NY65237GMedicare PIN
NY00741277Medicaid
NY65237AMedicare PIN