Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Wade K.c. Licup, MD

Individual provider Family Medicine Physician · NPI 1881157998

Dr. Wade K.c. Licup, MD is a Family Practice in Vista, California. Qualified in 2019, 7 years ago. Practices with Scripps Health, a 1,446-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
7
Licensed in
CA
In the registry since
2019
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

130 Cedar Rd
Vista, CA 92083-5102
Phone: (760) 806-5500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 4560 Admiralty Way Ste 100, Marina Del Rey, CA 90292-5424 — (310) 827-3700
  • 333 Mercy Ave, Merced, CA 95340-8319 — (209) 564-5000

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A179911 (CA)

Record details

NPI number1881157998
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 8, 2019
Last updated in NPPESApril 28, 2023
Certification dateApril 28, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Scripps Health — 1446 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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