Healthcare Provider Details

I. General information

NPI: 1942866868
Provider Name (Legal Business Name): ANGIE YAU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 09/29/2026
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SOUTH ST
BOSTON MA
02111-2826
US

IV. Provider business mailing address

11 GRANGER ST
QUINCY MA
02170-1309
US

V. Phone/Fax

Practice location:
  • Phone: 617-521-6730
  • Fax:
Mailing address:
  • Phone: 617-894-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858286
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: