MEDICARE: SANG C YU DMD

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	122300000X	Dentist	3523	NV

General Provider Information

NPI Number	:	1316020084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANG C YU DMD

Provider Business Mailing Address
First Line	:	1500 E DESERT INN RD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2550
Country	:	US
Telephone Number	:	702-862-8550
Fax Number	:	702-892-8431

Provider Business Practice Location Address
First Line	:	1500 E DESERT INN RD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2550
Country	:	US
Telephone Number	:	702-862-8550
Fax Number	:	702-892-8431

Authorized Official
Title or Position	:	PRESEDENT/DENTIST
Name	:	SANG CHIN YU
Credential	:	DMD
Telephone Number	:	702-862-8550

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/07/2011

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