Provider Demographics
NPI:1962427393
Name:OU, LICHUN (OMD,LAC,PHD,QME)
Entity type:Individual
Prefix:
First Name:LICHUN
Middle Name:
Last Name:OU
Suffix:
Gender:M
Credentials:OMD,LAC,PHD,QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1005
Mailing Address - Country:US
Mailing Address - Phone:510-420-0463
Mailing Address - Fax:510-595-3893
Practice Address - Street 1:3905 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1005
Practice Address - Country:US
Practice Address - Phone:510-420-0463
Practice Address - Fax:510-595-3893
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist