Healthcare Provider Details

I. General information

NPI: 1235383183
Provider Name (Legal Business Name): GEORGE WU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LAKES DR STE 100
WEST COVINA CA
91790-2929
US

IV. Provider business mailing address

1050 LAKES DR STE 100
WEST COVINA CA
91790-2929
US

V. Phone/Fax

Practice location:
  • Phone: 626-598-1012
  • Fax: 626-598-1013
Mailing address:
  • Phone: 626-598-1012
  • Fax: 626-598-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10460
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: