MEDICARE: PERRY Y JUE DMD INC

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	1223G0001X	General Practice Dentistry	41430	CA

General Provider Information

NPI Number	:	1700922382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY Y JUE DMD INC

Provider Business Mailing Address
First Line	:	5101 COMMERCE DRIVE
Second Line	:	SUITE #102
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0413
Country	:	US
Telephone Number	:	661-323-1500
Fax Number	:	661-323-1767

Provider Business Practice Location Address
First Line	:	5101 COMMERCE DRIVE
Second Line	:	SUITE #102
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0413
Country	:	US
Telephone Number	:	661-323-1500
Fax Number	:	661-323-1767

Authorized Official
Title or Position	:	SHAREHOLDER
Name	:	DR. PERRY Y JUE
Credential	:
Telephone Number	:	661-323-1500

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/05/2012

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