Healthcare Provider Details

I. General information

NPI: 1316000532
Provider Name (Legal Business Name): DAVID YU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 PAXTON AVE
CALUMET CITY IL
60409-1509
US

IV. Provider business mailing address

3356 S NORMAL AVE
CHICAGO IL
60616-3513
US

V. Phone/Fax

Practice location:
  • Phone: 708-868-2888
  • Fax: 708-868-2867
Mailing address:
  • Phone: 773-268-3366
  • Fax: 773-268-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: