Provider Demographics
NPI:1700167863
Name:WU, SUSANNE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:K
Last Name:WU
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 1:1660 WESTWOOD DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5100
Mailing Address - Country:US
Mailing Address - Phone:408-978-1103
Mailing Address - Fax:
Practice Address - Street 1:1660 WESTWOOD DR
Practice Address - Street 2:SUITE H
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5100
Practice Address - Country:US
Practice Address - Phone:408-978-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist