Provider Demographics
NPI:1639609340
Name:WU, ZI JIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZI JIAN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 BROOKSEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8337
Mailing Address - Country:US
Mailing Address - Phone:312-841-6139
Mailing Address - Fax:
Practice Address - Street 1:221 N WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-1508
Practice Address - Country:US
Practice Address - Phone:312-841-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0155111223G0001X
IL019.0311561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice