Healthcare Provider Details

I. General information

NPI: 1326472176
Provider Name (Legal Business Name): PEICHING PEGGY WU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY P. WU

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21619 PARKVIEW CT
WALNUT CA
91789-1414
US

IV. Provider business mailing address

21619 PARKVIEW CT
WALNUT CA
91789-1414
US

V. Phone/Fax

Practice location:
  • Phone: 909-444-3138
  • Fax: 909-444-3138
Mailing address:
  • Phone: 909-444-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: