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1265295117 NPI number — JACKIE JIAQI WU RD

NPI Number: 1265295117
Health Care Provider/Practitioner: JACKIE JIAQI WU RD

Information about “1265295117” NPI (JACKIE JIAQI WU RD) exists in 1265295117 in HTML format HTML  |  1265295117 in plain Text format TXT  |  1265295117 in PDF (Portable Document Format) PDF  |  1265295117 in an XML format XML  formats.

NPI Number : 1265295117 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265295117",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WU",
    "FirstName": "JACKIE",
    "MiddleName": "JIAQI",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "18001 N 79TH AVE STE A12",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85308-8398",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "623-399-6825",
    "MailingAddressFaxNumber": "623-505-3474",
    "FirstLinePracticeLocationAddress": "10000 N 31ST AVE STE C105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHOENIX",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85051-9625",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-674-1068",
    "PracticeLocationAddressFaxNumber": "480-247-5461",
    "EnumerationDate": "02/02/2024",
    "LastUpdateDate": "12/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "164.009460",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "86377434",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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