Provider Demographics
NPI:1003902644
Name:WU, JONATHAN HWAKAN (L,ACPHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HWAKAN
Last Name:WU
Suffix:
Gender:M
Credentials:L,ACPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1338
Mailing Address - Country:US
Mailing Address - Phone:323-255-6060
Mailing Address - Fax:323-255-6260
Practice Address - Street 1:1718 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1338
Practice Address - Country:US
Practice Address - Phone:323-255-6060
Practice Address - Fax:323-255-6260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist