=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922790682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JINGWEN WU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2023
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4460 BLACK AVE STE C
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-6139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-523-2120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 673 SANDALWOOD DR UNIT 2
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94551-6566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-231-9264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC18211
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------