Healthcare Provider Details

I. General information

NPI: 1205123767
Provider Name (Legal Business Name): LIN WU L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 WALNUT AVE #4
TUSTIN CA
92780-6944
US

IV. Provider business mailing address

2512 WALNUT AVE #4
TUSTIN CA
92780-6944
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-7575
  • Fax:
Mailing address:
  • Phone: 714-838-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: