Basic Information
Provider Information
NPI: 1578996112
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: MICHAEL
MiddleName: WU
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 PASTEUR DRIVE
Address2: LANE 154
City: STANFORD
State: CA
PostalCode: 943055133
CountryCode: US
TelephoneNumber: 6507236661
FaxNumber: 6504986205
Practice Location
Address1: 300 PASTEUR DR
Address2: LANE 154
City: STANFORD
State: CA
PostalCode: 943055133
CountryCode: US
TelephoneNumber: 6507236661
FaxNumber: 6504986205
Other Information
ProviderEnumerationDate: 08/19/2013
LastUpdateDate: 07/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA151271CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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