Provider Demographics
NPI:1689788374
Name:WU, HUAYANG JOHN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HUAYANG
Middle Name:JOHN
Last Name:WU
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:HUAYANG
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1702 MIRAMONTE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3773
Mailing Address - Country:US
Mailing Address - Phone:650-718-5086
Mailing Address - Fax:650-718-5088
Practice Address - Street 1:1702 MIRAMONTE AVE STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3773
Practice Address - Country:US
Practice Address - Phone:650-718-5086
Practice Address - Fax:650-718-5088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54040OtherDENTAL BOARD OF CALIFORNIA