Healthcare Provider Details

I. General information

NPI: 1184840605
Provider Name (Legal Business Name): SHAWN YU, DMD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19613 YORBA LINDA BLVD
YORBA LINDA CA
92886-3528
US

IV. Provider business mailing address

19613 YORBA LINDA BLVD
YORBA LINDA CA
92886-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-970-0833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number46349
License Number StateCA

VIII. Authorized Official

Name: SHAWN YU
Title or Position: PRESIDENT
Credential:
Phone: 714-970-0833