MEDICARE: DRS YU & XU DENTAL CORPORATION

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	1223G0001X	General Practice Dentistry	48413	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G8983501	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1609055227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS YU & XU DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1520 N MOUNTAIN AVE STE 123
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1132
Country	:	US
Telephone Number	:	909-988-9690
Fax Number	:	909-988-5372

Provider Business Practice Location Address
First Line	:	1520 N MOUNTAIN AVE STE 123
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1132
Country	:	US
Telephone Number	:	909-988-9690
Fax Number	:	909-988-5372

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HAO YU
Credential	:	DDS
Telephone Number	:	909-988-9690

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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