Healthcare Provider Details

I. General information

NPI: 1194309591
Provider Name (Legal Business Name): JARED WU, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13275 SOUTH ST
CERRITOS CA
90703-7307
US

IV. Provider business mailing address

13275 SOUTH ST
CERRITOS CA
90703-7307
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-8663
  • Fax: 562-924-8663
Mailing address:
  • Phone: 562-924-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED WU
Title or Position: PRESIDENT
Credential: DDS
Phone: 562-777-5787