Provider Demographics
NPI:1083967814
Name:WU, XIAOHONG (LAC)
Entity Type:Individual
Prefix:MS
First Name:XIAOHONG
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2869 S BASCOM AVE APT 506
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6281
Mailing Address - Country:US
Mailing Address - Phone:408-410-8626
Mailing Address - Fax:
Practice Address - Street 1:1799 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5433
Practice Address - Country:US
Practice Address - Phone:408-410-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist