Provider Demographics
NPI:1053619270
Name:WU, LILY C (LAC, AP)
Entity type:Individual
Prefix:MS
First Name:LILY
Middle Name:C
Last Name:WU
Suffix:
Gender:F
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 MLK ST N APT 13101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1633
Mailing Address - Country:US
Mailing Address - Phone:917-379-8515
Mailing Address - Fax:
Practice Address - Street 1:257 S CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1817
Practice Address - Country:US
Practice Address - Phone:917-379-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4686171100000X
NY004540171100000X
CA17421171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist