MEDICARE: BO YU DDS, PHD, FACD

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	101053	CA

General Provider Information

NPI Number	:	1851823082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BO YU DDS, PHD, FACD

Provider Business Mailing Address
First Line	:	390 S SEPULVEDA BLVD APT 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3141
Country	:	US
Telephone Number	:	424-393-6558
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	12/01/2025

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