Provider Demographics
NPI:1700942992
Name:FANG, JURIE DU (DDS)
Entity Type:Individual
Prefix:DR
First Name:JURIE
Middle Name:DU
Last Name:FANG
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 1:2096 W. LA HABRA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5007
Mailing Address - Country:US
Mailing Address - Phone:562-905-1828
Mailing Address - Fax:562-905-1180
Practice Address - Street 1:2096 W. LA HABRA BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5007
Practice Address - Country:US
Practice Address - Phone:562-905-1828
Practice Address - Fax:562-905-1180
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41074OtherDENTI-CAL RENDERING PIN