Healthcare Provider Details

I. General information

NPI: 1396286167
Provider Name (Legal Business Name): MENG-JU DU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W MAIN ST
RIPON CA
95366-3005
US

IV. Provider business mailing address

UCLA SCHOOL OF DENTISTRY 10833 LE CONTE AVE. BOX 951668
LOS ANGELES CA
90095-1668
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-4239
  • Fax: 209-599-7899
Mailing address:
  • Phone: 310-825-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104908
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: