Provider Demographics
NPI:1558184820
Name:XU, WANJUN
Entity type:Individual
Prefix:
First Name:WANJUN
Middle Name:
Last Name:XU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHAMROCK
Other - Middle Name:
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1850 ROUND ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4023
Mailing Address - Country:US
Mailing Address - Phone:512-270-0393
Mailing Address - Fax:
Practice Address - Street 1:1850 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4023
Practice Address - Country:US
Practice Address - Phone:512-270-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001148171100000X
TXAC02061171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist