MEDICARE: YANG YANG YU D.M.D, INC

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	:	1497387310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YANG YANG YU D.M.D, INC

Provider Business Mailing Address
First Line	:	23595 MOULTON PKWY STE I
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1939
Country	:	US
Telephone Number	:	949-317-3197
Fax Number	:	949-317-3198

Provider Business Practice Location Address
First Line	:	23595 MOULTON PKWY STE I
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1939
Country	:	US
Telephone Number	:	949-317-3197
Fax Number	:	949-317-3198

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YANG YANG YU
Credential	:	DMD
Telephone Number	:	949-317-3197

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	02/08/2020

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