Jimmy Wu, DDS, Professional Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

47019 Issued in CA

Legal business name

JIMMY WU, DDS, PROFESSIONAL DENTAL CORPORATION

Practice address

1301 Ynez PL
Coronado, CA 92118-2925

Phone

(619) 435-6227

Fax

(619) 435-4117

NPI assigned

Dec 9, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jimmy Wu, DDS

Title

Ceo/Dentist

Phone

(619) 992-5774

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1215205968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 YNEZ PLACE",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "92118",
            "telephone_number": "619-435-6227",
            "fax_number": "619-435-4117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 YNEZ PL",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921182925",
            "telephone_number": "619-435-6227",
            "fax_number": "619-435-4117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIMMY WU, DDS, PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_title_or_position": "CEO/DENTIST",
        "authorized_official_telephone_number": "619-992-5774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "47019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Coronado, CA
• Providers in Coronado, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.