MEDICARE: CECILIA JU

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	45885	CA

General Provider Information

NPI Number	:	1942434170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA JU

Provider Business Mailing Address
First Line	:	140 EL CAMINO REAL
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2606
Country	:	US
Telephone Number	:	650-259-9896
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 EL CAMINO REAL
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2606
Country	:	US
Telephone Number	:	650-259-9896
Fax Number	:

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

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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Directions to “ CECILIA JU ” Practice Location

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