Basic Information
| Provider Information | |||||||||
| NPI: | 1255303632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WU | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15906 MILL CREEK BLVD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980121797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253852009 | ||||||||
| FaxNumber: | 4259390807 | ||||||||
| Practice Location | |||||||||
| Address1: | 15906 MILL CREEK BLVD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980121797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253852009 | ||||||||
| FaxNumber: | 4259390807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 0102201216 | VA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 6867 | AK | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | OP 60212402 | WA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | MD1434 | 05 | AK | MEDICAID |