Provider Demographics
NPI:1689705428
Name:WU, WEN
Entity Type:Individual
Prefix:DR
First Name:WEN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1289 E HILLSDALE BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1294
Mailing Address - Country:US
Mailing Address - Phone:650-638-9688
Mailing Address - Fax:650-638-9689
Practice Address - Street 1:1289 E HILLSDALE BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1294
Practice Address - Country:US
Practice Address - Phone:650-638-9688
Practice Address - Fax:650-638-9689
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice