Healthcare Provider Details

I. General information

NPI: 1942904792
Provider Name (Legal Business Name): MICHELLE S YU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RUCKER AVE
EVERETT WA
98203-2215
US

IV. Provider business mailing address

4201 RUCKER AVE
EVERETT WA
98203-2215
US

V. Phone/Fax

Practice location:
  • Phone: 425-382-4000
  • Fax:
Mailing address:
  • Phone: 425-382-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61515607
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: