Provider Demographics
NPI:1750793360
Name:WU, MONICA (DDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
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 1:1393 CABRILLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2210
Mailing Address - Country:US
Mailing Address - Phone:571-242-5592
Mailing Address - Fax:
Practice Address - Street 1:670 RIVEROAKS PARKWAY
Practice Address - Street 2:SUITE J
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-9513
Practice Address - Country:US
Practice Address - Phone:408-894-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63108122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist