Provider Demographics
NPI:1972036507
Name:WU, JARED (DDS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13275 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7307
Mailing Address - Country:US
Mailing Address - Phone:562-924-8663
Mailing Address - Fax:562-924-8890
Practice Address - Street 1:13275 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7307
Practice Address - Country:US
Practice Address - Phone:562-924-8663
Practice Address - Fax:562-924-8890
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1029721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice