=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831485457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUN WU DDS MSEE PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2011
-----------------------------------------------------
Last Update Date | 08/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9750 BELLAIRE BLVD STE 250
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-409-7168
-----------------------------------------------------
Fax | 832-777-7056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5511 BARON RIDGE LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-6613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-332-2172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 27077
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------