Provider Demographics
NPI:1497810170
Name:HUI, WALLY T (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALLY
Middle Name:T
Last Name:HUI
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 1:3328 S. DEL MAR AVE.
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2330
Mailing Address - Country:US
Mailing Address - Phone:626-288-9328
Mailing Address - Fax:626-288-9320
Practice Address - Street 1:3328 S. DEL MAR AVE.
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2330
Practice Address - Country:US
Practice Address - Phone:626-288-9328
Practice Address - Fax:626-288-9320
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513391223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice