Provider Demographics
NPI:1548626260
Name:WU, JENG CHANG
Entity type:Individual
Prefix:
First Name:JENG
Middle Name:CHANG
Last Name:WU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1513
Mailing Address - Country:US
Mailing Address - Phone:562-600-0138
Mailing Address - Fax:888-308-0138
Practice Address - Street 1:8826 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1513
Practice Address - Country:US
Practice Address - Phone:562-600-0138
Practice Address - Fax:888-308-0138
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC15379OtherCALIFORNIA LICENSED ACUPUNCTURIST