Provider Demographics
NPI:1356015200
Name:WU, JU QUAN
Entity Type:Individual
Prefix:DR
First Name:JU
Middle Name:QUAN
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 1:9106 BEARCOVE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-8896
Mailing Address - Country:US
Mailing Address - Phone:573-837-3918
Mailing Address - Fax:
Practice Address - Street 1:3730 S GESSNER RD STE C-100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5132
Practice Address - Country:US
Practice Address - Phone:832-834-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice