Provider Demographics
NPI:1710573050
Name:HUAYANG JOHN WU, DDS, INC.
Entity Type:Organization
Organization Name:HUAYANG JOHN WU, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUAYANG
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-718-5086
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54040OtherDENTAL BOARD OF CALIFORNIA