Provider Demographics
NPI:1588291991
Name:CHIU, WAI (LAC)
Entity type:Individual
Prefix:
First Name:WAI
Middle Name:
Last Name:CHIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LILY CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1473
Mailing Address - Country:US
Mailing Address - Phone:732-546-1351
Mailing Address - Fax:
Practice Address - Street 1:721 N BEERS ST STE 1E
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1500
Practice Address - Country:US
Practice Address - Phone:732-546-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00047600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty