Provider Demographics
NPI:1871553834
Name:WU, DAFANG (MD)
Entity type:Individual
Prefix:
First Name:DAFANG
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3195 FOLSOM BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5264
Mailing Address - Country:US
Mailing Address - Phone:916-378-5541
Mailing Address - Fax:916-739-0789
Practice Address - Street 1:3195 FOLSOM BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5264
Practice Address - Country:US
Practice Address - Phone:916-378-5541
Practice Address - Fax:916-739-0789
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301081007207U00000X
CAA77987207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4761586Medicaid
MI4761586Medicaid