Provider Demographics
NPI:1114953841
Name:JU, WERNER W (MD)
Entity Type:Individual
Prefix:DR
First Name:WERNER
Middle Name:W
Last Name:JU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6399 SAN IGNACIO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13847 E 14TH ST STE 218
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-483-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42898207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G428980OtherMEDI-CAL
CA070014445OtherRAILROAD MEDICARE-SM
AR070002127OtherRAILROAD MEDICARE-SL
CA05D0600577OtherCLIA- SAN LEANDRO
CA05D0596816OtherCLIA-SAN MATEO
CAG42898OtherSTATE LICENSE #
CAG42898OtherSTATE LICENSE #
CA05D0600577OtherCLIA- SAN LEANDRO
AR070002127OtherRAILROAD MEDICARE-SL
CAA49153Medicare UPIN