Provider Demographics
NPI:1871774661
Name:WU, ELIZABETH FAY SHU (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAY SHU
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 1:2504 SAMARITAN DR
Mailing Address - Street 2:STE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4005
Mailing Address - Country:US
Mailing Address - Phone:408-358-1804
Mailing Address - Fax:408-358-1807
Practice Address - Street 1:2504 SAMARITAN DR
Practice Address - Street 2:STE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4005
Practice Address - Country:US
Practice Address - Phone:408-358-1804
Practice Address - Fax:408-358-1807
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG46940Medicare UPIN
CA00G823320Medicare PIN