Healthcare Provider Details

I. General information

NPI: 1669394235
Provider Name (Legal Business Name): KUAN-CHEN WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON WU

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 HOMESTEAD RD
CUPERTINO CA
95014-0600
US

IV. Provider business mailing address

45212 S GRIMMER BLVD
FREMONT CA
94539-6657
US

V. Phone/Fax

Practice location:
  • Phone: 978-654-1600
  • Fax:
Mailing address:
  • Phone: 978-654-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: