Provider Demographics
NPI:1134623036
Name:WU, ITING (LAC)
Entity type:Individual
Prefix:
First Name:ITING
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 UNIVERSITY AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2310
Mailing Address - Country:US
Mailing Address - Phone:646-883-8321
Mailing Address - Fax:
Practice Address - Street 1:2845 UNIVERSITY AVE APT 3H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2310
Practice Address - Country:US
Practice Address - Phone:646-883-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist