MEDICARE: YIDI ORTHODONTICS, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1326860685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YIDI ORTHODONTICS, LLC

Provider Business Mailing Address
First Line	:	3451 WYNDHAM WAY STE B
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-5508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 WYNDHAM WAY STE B
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-5508
Country	:	US
Telephone Number	:	650-918-0918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YIDI LIU
Credential	:
Telephone Number	:	765-801-0808

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	02/27/2025

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