Healthcare Provider Details

I. General information

NPI: 1336649854
Provider Name (Legal Business Name): WEN JUN WENDY SHI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WEN JUN WENDY DAI LAC

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12035 ANDERSON RD
WILLIS TX
77318-5511
US

IV. Provider business mailing address

12619 PEGASUS DR
WILLIS TX
77318-5074
US

V. Phone/Fax

Practice location:
  • Phone: 281-818-9996
  • Fax:
Mailing address:
  • Phone: 281-871-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: