Provider Demographics
NPI:1548295371
Name:FU, VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHIH-WEN
Other - Middle Name:
Other - Last Name:FU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:SUITE #416
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-881-2451
Mailing Address - Fax:909-881-4276
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE #416
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-881-2451
Practice Address - Fax:909-881-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37728207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377280Medicaid
CA00A377280Medicaid
CA00A377280Medicare ID - Type UnspecifiedMEDICARE