Healthcare Provider Details

I. General information

NPI: 1174218978
Provider Name (Legal Business Name): JIAJIA YU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIMONIDES MEDICAL CENTER 4802 10TH AVENUE
BROOKLYN NY
11219
US

IV. Provider business mailing address

MAIMONIDES MEDICAL CENTER 4802 10TH AVENUE
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number063952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: