Provider Demographics
NPI:1093292385
Name:HU, CHARLES WENCHAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WENCHAO
Last Name:HU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 TERRY AVE UNIT 615
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2296
Mailing Address - Country:US
Mailing Address - Phone:626-203-5240
Mailing Address - Fax:
Practice Address - Street 1:17220 140TH AVE SE STE C
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7000
Practice Address - Country:US
Practice Address - Phone:425-270-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE609814321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty