Healthcare Provider Details

I. General information

NPI: 1003030404
Provider Name (Legal Business Name): QUINN YU DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 LA SIERRA AVE SUITE 108,109,110
RIVERSIDE CA
92503
US

IV. Provider business mailing address

3380 LA SIERRA AVE SUITE 108,109,110
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-354-9999
  • Fax: 951-354-6666
Mailing address:
  • Phone: 951-354-9999
  • Fax: 951-354-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48698
License Number StateCA

VIII. Authorized Official

Name: QUINN YU
Title or Position: OWNER
Credential:
Phone: 951-354-9999