Provider Demographics
NPI:1023373156
Name:WU, DIANA CHOA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CHOA
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 NW MAPLE STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-654-8601
Mailing Address - Fax:425-654-2561
Practice Address - Street 1:1740 NW MAPLE STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-654-8601
Practice Address - Fax:425-654-2561
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60351041122300000X
TX28085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist