Healthcare Provider Details

I. General information

NPI: 1316176159
Provider Name (Legal Business Name): JASON W YU DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ROLLINS ST STE 4700
ORLANDO FL
32804-5534
US

IV. Provider business mailing address

265 E ROLLINS ST STE 4700
ORLANDO FL
32804-5534
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3655
  • Fax:
Mailing address:
  • Phone: 407-821-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number278199
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberDR.0067992
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME179941
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA170353
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number278199
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: