Provider Demographics
NPI:1235442765
Name:WU, DAN (LAC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3324
Mailing Address - Country:US
Mailing Address - Phone:310-358-0276
Mailing Address - Fax:310-359-1464
Practice Address - Street 1:240 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3324
Practice Address - Country:US
Practice Address - Phone:310-358-0276
Practice Address - Fax:310-359-1464
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist