Provider Demographics
NPI:1841846292
Name:JERRY K WU DMD INC
Entity type:Organization
Organization Name:JERRY K WU DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-838-0010
Mailing Address - Street 1:1254 IRVINE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3573
Mailing Address - Country:US
Mailing Address - Phone:714-828-0010
Mailing Address - Fax:
Practice Address - Street 1:1254 IRVINE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3573
Practice Address - Country:US
Practice Address - Phone:714-828-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty