Provider Demographics
NPI:1447487798
Name:HU, CAROLINE (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:HU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 FOOTHILL BLVD
Mailing Address - Street 2:#381
Mailing Address - City:LA CRESENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214
Mailing Address - Country:US
Mailing Address - Phone:954-547-1858
Mailing Address - Fax:
Practice Address - Street 1:2629 FOOTHILL BLVD
Practice Address - Street 2:#381
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3511
Practice Address - Country:US
Practice Address - Phone:954-547-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000085-1122300000X
NY0552411223G0001X
CA612261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice