Healthcare Provider Details

I. General information

NPI: 1932487162
Provider Name (Legal Business Name): CHARLES JI-CHYUAN YAU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SCHOOL ST
RYE NY
10580-2952
US

IV. Provider business mailing address

225 RECTOR PL APT 9T
NEW YORK NY
10280-1116
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-5735
  • Fax:
Mailing address:
  • Phone: 267-679-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number055546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: