Healthcare Provider Details

I. General information

NPI: 1851823082
Provider Name (Legal Business Name): BO YU DDS, PHD, FACD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-2208
US

IV. Provider business mailing address

390 S SEPULVEDA BLVD APT 305
LOS ANGELES CA
90049-3141
US

V. Phone/Fax

Practice location:
  • Phone: 909-903-8885
  • Fax:
Mailing address:
  • Phone: 424-393-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: