Healthcare Provider Details

I. General information

NPI: 1386218329
Provider Name (Legal Business Name): KATHERINE YIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 YOPP RD STE 308
JACKSONVILLE NC
28540-3683
US

IV. Provider business mailing address

571 YOPP RD STE 308
JACKSONVILLE NC
28540-3683
US

V. Phone/Fax

Practice location:
  • Phone: 910-716-0101
  • Fax: 910-294-8874
Mailing address:
  • Phone: 910-716-0101
  • Fax: 910-294-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: