Provider Demographics
NPI:1699839977
Name:WU, RUTH S (DDS)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:S
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-5257
Mailing Address - Country:US
Mailing Address - Phone:323-721-5121
Mailing Address - Fax:323-721-4491
Practice Address - Street 1:149 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-5257
Practice Address - Country:US
Practice Address - Phone:323-721-5121
Practice Address - Fax:323-721-4491
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADL281121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL28112OtherLICENSE
CAB28112-01Medicaid