Provider Demographics
NPI:1194888990
Name:WU, JING (LAC, OMD)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13424 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8810
Mailing Address - Country:US
Mailing Address - Phone:562-275-3405
Mailing Address - Fax:
Practice Address - Street 1:7931 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1848
Practice Address - Country:US
Practice Address - Phone:714-562-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8454171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist