Provider Demographics
NPI:1235500984
Name:WU, TEH-CHIN LILY (RD)
Entity Type:Individual
Prefix:MISS
First Name:TEH-CHIN
Middle Name:LILY
Last Name:WU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1545 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-9064
Mailing Address - Country:US
Mailing Address - Phone:310-634-5459
Mailing Address - Fax:
Practice Address - Street 1:3160 CORPORATE PL
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-3916
Practice Address - Country:US
Practice Address - Phone:510-732-8800
Practice Address - Fax:510-732-8435
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA876026133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered