MEDICARE: WALDEN Y YU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	45067	CA

General Provider Information

NPI Number	:	1154333672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALDEN Y YU DDS

Provider Business Mailing Address
First Line	:	11491 JEFFERSON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6115
Country	:	US
Telephone Number	:	310-397-1806
Fax Number	:	310-397-1808

Provider Business Practice Location Address
First Line	:	11491 JEFFERSON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6115
Country	:	US
Telephone Number	:	310-397-1806
Fax Number	:	310-397-1808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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