Healthcare Provider Details

I. General information

NPI: 1770932253
Provider Name (Legal Business Name): JENNIFER YAU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 01/23/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 RITCHIE HWY
PASADENA MD
21122-3944
US

IV. Provider business mailing address

8352 RITCHIE HWY
PASADENA MD
21122-3944
US

V. Phone/Fax

Practice location:
  • Phone: 410-647-3595
  • Fax:
Mailing address:
  • Phone: 410-647-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415540
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17103
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: