Provider Demographics
NPI:1740978956
Name:JERRY C HU
Entity type:Organization
Organization Name:JERRY C HU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-640-7401
Mailing Address - Street 1:2983 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3204
Mailing Address - Country:US
Mailing Address - Phone:516-640-7401
Mailing Address - Fax:855-201-3647
Practice Address - Street 1:12570 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3532
Practice Address - Country:US
Practice Address - Phone:855-244-7533
Practice Address - Fax:855-201-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty