MEDICARE: DR. JENNIFER TSAI PIN WU DDS

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	3515	NV

General Provider Information

NPI Number	:	1841346343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER TSAI PIN WU DDS

Provider Business Mailing Address
First Line	:	300 N ROYAL ASCOT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4306
Country	:	US
Telephone Number	:	702-480-9361
Fax Number	:	702-363-1172

Provider Business Practice Location Address
First Line	:	7520 W WASHINGTON AVE
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4330
Country	:	US
Telephone Number	:	702-363-1590
Fax Number	:	702-363-1172

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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