Provider Demographics
NPI:1982733689
Name:FENGHUA FU D.D.S., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FENGHUA FU D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:LOS ANGELES DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FENGHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-917-3088
Mailing Address - Street 1:13704 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746
Mailing Address - Country:US
Mailing Address - Phone:626-917-3088
Mailing Address - Fax:626-917-9333
Practice Address - Street 1:13704 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746
Practice Address - Country:US
Practice Address - Phone:626-917-3088
Practice Address - Fax:626-917-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93197-01Medicare ID - Type UnspecifiedDENTI-CAL BILLING PROVIDE