MEDICARE: YANG YANG 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	30.025200	OH
2	122300000X	Dentist	103715	CA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	122300000X	Dentist	DE61286676	WA

General Provider Information

NPI Number	:	1720440936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANG YANG YU DMD

Provider Business Mailing Address
First Line	:	301 E JEANETTE LN UNIT 147
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-6027
Country	:	US
Telephone Number	:	502-767-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 SW SCOTTON WAY STE 101
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-2715
Country	:	US
Telephone Number	:	360-843-2001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2016
Last Update Date	:	06/14/2022

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