Healthcare Provider Details

I. General information

NPI: 1093424871
Provider Name (Legal Business Name): YI LUO DDS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20065 STEVENS CREEK BLVD BLDG A
CUPERTINO CA
95014-2350
US

IV. Provider business mailing address

20065 STEVENS CREEK BLVD BLDG A
CUPERTINO CA
95014-2350
US

V. Phone/Fax

Practice location:
  • Phone: 310-986-1271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: YI LUO
Title or Position: CEO
Credential:
Phone: 408-777-8998