Healthcare Provider Details

I. General information

NPI: 1710573050
Provider Name (Legal Business Name): HUAYANG JOHN WU, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 MIRAMONTE AVE STE B
MOUNTAIN VIEW CA
94040-3773
US

IV. Provider business mailing address

1702 MIRAMONTE AVE STE B
MOUNTAIN VIEW CA
94040-3773
US

V. Phone/Fax

Practice location:
  • Phone: 650-718-5086
  • Fax: 650-718-5088
Mailing address:
  • Phone: 650-718-5086
  • Fax: 650-718-5088

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: DR. HUAYANG WU
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 650-718-5086