Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 104746 | CA |
NPI | 1154095164 |
---|---|
Provider Name | Dr. Wendy Fu |
First Address | San Francisco, CA 94121-1667 |
Second Address | San Francisco, CA 94143-2210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |