Provider Demographics
NPI:1912075094
Name:WU, XIAO FU (DMD, MS)
Entity type:Individual
Prefix:
First Name:XIAO
Middle Name:FU
Last Name:WU
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:1477 FLORIBUNDA AVE
Mailing Address - Street 2:#306
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-7516
Mailing Address - Country:US
Mailing Address - Phone:650-548-1088
Mailing Address - Fax:
Practice Address - Street 1:1477 FLORIBUNDA AVE
Practice Address - Street 2:#306
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-7516
Practice Address - Country:US
Practice Address - Phone:650-548-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557471223X0400X
MA217491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics