Active NPI
Jeff Wu
- Dentist
- Alhambra, CA
National Provider Identifier
1124472287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 100120
- Practice address
- 2201 Whitney Dr
Alhambra, CA 91803-3842 - Phone
- (626) 476-5097
- NPI assigned
- Apr 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 100120 | CA | Primary |
Addresses
Primary practice location
2201 Whitney Dr
Alhambra, CA 91803-3842
Mailing address
2201 Whitney Dr
Alhambra, CA 91803-3842
Phone (626) 476-5097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160808001047 | NM | Order and Referring Only - Other (Physician) | 1850685215 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100120 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641340800000",
"number": "1124472287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 WHITNEY DR",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918033842",
"telephone_number": "626-476-5097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 WHITNEY DR",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918033842",
"telephone_number": "626-476-5097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WU",
"first_name": "JEFF",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-14",
"last_updated": "2022-01-05",
"certification_date": "2022-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "100120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alhambra, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.