Provider Demographics
NPI:1912356817
Name:WUU, RROBERT-JIM (LAC)
Entity Type:Individual
Prefix:
First Name:RROBERT-JIM
Middle Name:
Last Name:WUU
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 1:250 BEL MARIN KEYS BLVD STE G6
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5727
Mailing Address - Country:US
Mailing Address - Phone:415-457-4540
Mailing Address - Fax:
Practice Address - Street 1:250 BEL MARIN KEYS BLVD STE G6
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5727
Practice Address - Country:US
Practice Address - Phone:415-457-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16523171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist