MEDICARE: DR. STEPHEN Y YU D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	31144	CA

General Provider Information

NPI Number	:	1780644724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN Y YU D.D.S.

Provider Business Mailing Address
First Line	:	17815 VENTURA BLVD
Second Line	:	SUITE 212
City	:	ENCINO
State	:	CA
Zip	:	91316-3610
Country	:	US
Telephone Number	:	818-708-4909
Fax Number	:	818-708-4919

Provider Business Practice Location Address
First Line	:	17815 VENTURA BLVD
Second Line	:	SUITE 212
City	:	ENCINO
State	:	CA
Zip	:	91316-3610
Country	:	US
Telephone Number	:	818-708-4909
Fax Number	:	818-708-4919

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/01/2011

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