Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 54039 | CA |
NPI | 1457428815 |
---|---|
Provider Name | Barbara Gene Wu |
First Address | San Jose, CA 95116-1903 |
Second Address | San Jose, CA 95116-1903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 04/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BW9993367 | DEA (01) | CA |