=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174427769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B S JU DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2302 S UNION AVE STE A2
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-752-5933
-----------------------------------------------------
Fax | 253-752-6535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2302 S UNION AVE STE A2
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-752-5933
-----------------------------------------------------
Fax | 253-752-6535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BANSUK JU
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 253-752-5933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------