Provider Demographics
NPI:1568717122
Name:WU, JEAN CHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CHIN
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:#204
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-760-6288
Mailing Address - Fax:949-760-5048
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:#204
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-760-6288
Practice Address - Fax:949-760-5048
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50404OtherDENTAL
BW8092366OtherDEA