Provider Demographics
NPI:1831220813
Name:WU, HOWARD JOHN (LAC)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:JOHN
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 1:310 W LINE ST # A
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3413
Mailing Address - Country:US
Mailing Address - Phone:760-872-9003
Mailing Address - Fax:
Practice Address - Street 1:310 W LINE ST # A
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3413
Practice Address - Country:US
Practice Address - Phone:760-872-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3520171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist