Provider Demographics
NPI:1093031247
Name:WU, TIANYUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIANYUN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:T
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:885 OLIVE AVE
Mailing Address - Street 2:A
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2420
Mailing Address - Country:US
Mailing Address - Phone:415-373-7827
Mailing Address - Fax:
Practice Address - Street 1:885 OLIVE AVE.
Practice Address - Street 2:A
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2420
Practice Address - Country:US
Practice Address - Phone:415-373-7827
Practice Address - Fax:415-897-6045
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13492171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist