Provider Demographics
NPI:1063744183
Name:WU, SHAO-JIUAN (LAC)
Entity type:Individual
Prefix:MRS
First Name:SHAO-JIUAN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:932 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4623
Mailing Address - Country:US
Mailing Address - Phone:408-220-3641
Mailing Address - Fax:
Practice Address - Street 1:100 OCONNOR DR
Practice Address - Street 2:SUITE 27
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1647
Practice Address - Country:US
Practice Address - Phone:408-220-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist