Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 2901020851 | MI |
Y | 1223P0221X | Pediatric Dentist | 30384 | TX |
NPI | 1063757623 |
---|---|
Provider Name | Dr. Di Wu |
First Address | Houston, TX 77030-1312 |
Second Address | Houston, TX 77030-1312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3390767-01 | (05) | TX |