Provider Demographics
NPI:1689898496
Name:WU, YAO NAN (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:YAO
Middle Name:NAN
Last Name:WU
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 BUFORD HWY NE STE G
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1119
Mailing Address - Country:US
Mailing Address - Phone:770-457-2833
Mailing Address - Fax:770-457-2710
Practice Address - Street 1:5095 BUFORD HWY NE STE G
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1119
Practice Address - Country:US
Practice Address - Phone:770-457-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAINV-12-06-5842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor