Provider Demographics
NPI:1982838579
Name:BRIAN M. WOO, D.D.S., M.D., INC.
Entity Type:Organization
Organization Name:BRIAN M. WOO, D.D.S., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:559-459-5120
Mailing Address - Street 1:290 NORTH WAYTE LANE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1324
Mailing Address - Country:US
Mailing Address - Phone:559-459-5120
Mailing Address - Fax:
Practice Address - Street 1:290 NORTH WAYTE LANE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1324
Practice Address - Country:US
Practice Address - Phone:559-459-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50017122300000X, 1223P0106X, 1223S0112X
CAA107428204E00000X, 2086S0122X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA 1484OtherGENERAL ANESTHESIA LICENSE
CAA107428OtherMEDICAL LICENSE
CA50017OtherDENTAL LICENSE
CABW8380381OtherDEA NUMBER