Healthcare Provider Details

I. General information

NPI: 1235442765
Provider Name (Legal Business Name): DAN WU L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S LA CIENEGA BLVD SUITE 104
BEVERLY HILLS CA
90211-3324
US

IV. Provider business mailing address

240 S LA CIENEGA BLVD SUITE 104
BEVERLY HILLS CA
90211-3324
US

V. Phone/Fax

Practice location:
  • Phone: 310-358-0276
  • Fax: 310-359-1464
Mailing address:
  • Phone: 310-358-0276
  • Fax: 310-359-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: