Healthcare Provider Details

I. General information

NPI: 1396189346
Provider Name (Legal Business Name): SHELLY CHIA JUEI WU L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 W DUARTE RD APT 7
ARCADIA CA
91007-7743
US

IV. Provider business mailing address

1167 W DUARTE RD APT 7
ARCADIA CA
91007-7743
US

V. Phone/Fax

Practice location:
  • Phone: 626-348-1693
  • Fax:
Mailing address:
  • Phone: 626-348-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: