Provider Demographics
NPI:1245363498
Name:HU, JAN C (DDS)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:HU
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 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-647-4166
Mailing Address - Fax:734-615-7294
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1078
Practice Address - Country:US
Practice Address - Phone:734-647-4166
Practice Address - Fax:734-615-7294
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017619122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667565Medicaid
MID176190OtherBCBS OF MI DENTAL
MI4747308Medicaid
MI4747317Medicaid
MI1958111960OtherBCBS OF MI MED SURGICAL
MI4747317Medicaid
MI0N65440018Medicare PIN