Healthcare Provider Details

I. General information

NPI: 1841846292
Provider Name (Legal Business Name): JERRY K WU DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 IRVINE BLVD STE 160
TUSTIN CA
92780-3573
US

IV. Provider business mailing address

1254 IRVINE BLVD STE 160
TUSTIN CA
92780-3573
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-0010
  • Fax:
Mailing address:
  • Phone: 714-828-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY K WU
Title or Position: PRESIDENT
Credential: DMD
Phone: 714-838-0010