Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 62351 | CA |
NPI | 1053758326 |
---|---|
Provider Name | Dr. Kimberley W Wu |
First Address | South Pasadena, CA 91030-3213 |
Second Address | South Pasadena, CA 91030-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2013 |
Last Update Date | 28/05/2013 |