MEDICARE: CAROLINE HU D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	000085-1	NY
2	1223G0001X	General Practice Dentistry	055241	NY
3	1223P0221X	Pediatric Dentistry	61226	CA

General Provider Information

NPI Number	:	1447487798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE HU D.M.D

Provider Business Mailing Address
First Line	:	2629 FOOTHILL BLVD
Second Line	:	#381
City	:	LA CRESENTA
State	:	CA
Zip	:	91214
Country	:	US
Telephone Number	:	954-547-1858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2629 FOOTHILL BLVD
Second Line	:	#381
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3511
Country	:	US
Telephone Number	:	954-547-1858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2009
Last Update Date	:	09/22/2021

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