Active NPI
Tiffany Wu
- Pediatric Dentistry
- Los Angeles, CA
National Provider Identifier
1982010427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 64331
- Practice address
- 5262 E Beverly Blvd
Los Angeles, CA 90022-2002 - Phone
- (323) 887-0088
- NPI assigned
- Jul 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 64331 | CA | Primary |
Addresses
Primary practice location
5262 E Beverly Blvd
Los Angeles, CA 90022-2002
Mailing address
406 E Fairview Avenue
San Gabriel, CA 91776-2002
Other practice location 1
100 E Newton St
Boston, MA 02118-2308
Phone (617) 638-4700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20160830002244 | CA | Order and Referring Only - Dentist | 8628363611 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64331 | CA | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1982010427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 E FAIRVIEW AVENUE",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917762002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5262 E BEVERLY BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900222002",
"telephone_number": "323-887-0088"
}
],
"practiceLocations": [
{
"address_1": "100 E Newton St",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021182308",
"country_code": "US",
"telephone_number": "617-638-4700",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WU",
"first_name": "TIFFANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-04",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "64331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.