MEDICARE: SHELLY XIAO YUE YU

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	1223G0001X	General Practice Dentistry	48869	CA

General Provider Information

NPI Number	:	1700993110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY XIAO YUE YU

Provider Business Mailing Address
First Line	:	15 GOLDENEYE CT
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-7369
Country	:	US
Telephone Number	:	530-345-6888
Fax Number	:	530-345-9988

Provider Business Practice Location Address
First Line	:	2571 CALIFORNIA PARK DR
Second Line	:	SUITE 120
City	:	CHICO
State	:	CA
Zip	:	95928-4042
Country	:	US
Telephone Number	:	530-345-6888
Fax Number	:	530-345-9988

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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