Healthcare Provider Details

I. General information

NPI: 1396539193
Provider Name (Legal Business Name): ADDISON YU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LENNON LN STE 101
WALNUT CREEK CA
94598-2467
US

IV. Provider business mailing address

301 LENNON LN STE 101
WALNUT CREEK CA
94598-2467
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-8668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: