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General NPI Number Information
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NPI Number | 1982010427
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Entity Type | Individual
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Provider Name | TIFFANY WU
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Gender | Female
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Dates
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Enumeration Date | 07/04/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5262 E BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-2002
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Country | US
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Telephone | 323-887-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 406 E FAIRVIEW AVENUE
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City | SAN GABRIEL
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State | CA
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Zip | 91776-2002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 64331
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License Number State | CA
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