Provider Demographics
NPI:1164206942
Name:WU, KUAN-I (MS, MSED)
Entity Type:Individual
Prefix:
First Name:KUAN-I
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MS, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-0151
Mailing Address - Country:US
Mailing Address - Phone:703-221-1263
Mailing Address - Fax:866-311-4280
Practice Address - Street 1:17606 DUMFRIES RD, SUITE 204
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026
Practice Address - Country:US
Practice Address - Phone:703-221-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001576101YP2500X
VA0704016137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional