Provider Demographics
NPI:1457694242
Name:LU, WENDY
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 S DE ANZA BLVD STE C103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3556
Mailing Address - Country:US
Mailing Address - Phone:408-255-9666
Mailing Address - Fax:408-255-4524
Practice Address - Street 1:1062 S DE ANZA BLVD STE C103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3556
Practice Address - Country:US
Practice Address - Phone:408-255-9666
Practice Address - Fax:408-255-4524
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice