MEDICARE: BO YU DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1073475745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BO YU DDS INC

Provider Business Mailing Address
First Line	:	1391 S DIAMOND BAR BLVD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-2208
Country	:	US
Telephone Number	:	909-903-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1391 S DIAMOND BAR BLVD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-2208
Country	:	US
Telephone Number	:	909-903-8885
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BO YU
Credential	:	DDS, PHD, FACD
Telephone Number	:	424-393-6558

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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