Provider Demographics
NPI:1114000106
Name:WU, GUANGNING (LAC, ADS)
Entity Type:Individual
Prefix:
First Name:GUANGNING
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:LAC, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 MAIN ST.
Mailing Address - Street 2:B.O. BOX 710
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862-0710
Mailing Address - Country:US
Mailing Address - Phone:607-692-3961
Mailing Address - Fax:607-692-2514
Practice Address - Street 1:2642 MAIN ST
Practice Address - Street 2:BO BOX 710
Practice Address - City:WHITNEY POINT
Practice Address - State:NY
Practice Address - Zip Code:13862-0710
Practice Address - Country:US
Practice Address - Phone:607-692-3961
Practice Address - Fax:607-692-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002831171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist