Provider Demographics
NPI:1396286167
Name:DU, MENG-JU
Entity type:Individual
Prefix:
First Name:MENG-JU
Middle Name:
Last Name:DU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCLA SCHOOL OF DENTISTRY
Mailing Address - Street 2:10833 LE CONTE AVE. BOX 951668
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-8031
Mailing Address - Fax:
Practice Address - Street 1:1150 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-3005
Practice Address - Country:US
Practice Address - Phone:209-599-4239
Practice Address - Fax:209-599-7899
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1049081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program