Provider Demographics
NPI:1205123767
Name:WU, LIN (LAC)
Entity type:Individual
Prefix:MR
First Name:LIN
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 1:2512 WALNUT AVE
Mailing Address - Street 2:#4
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6944
Mailing Address - Country:US
Mailing Address - Phone:714-838-7575
Mailing Address - Fax:
Practice Address - Street 1:2512 WALNUT AVE
Practice Address - Street 2:#4
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6944
Practice Address - Country:US
Practice Address - Phone:714-838-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist