MEDICARE: DR. YUYAO XU 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	122300000X	Dentist	DDS101774	CA

General Provider Information

NPI Number	:	1871019166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YUYAO XU DDS

Provider Business Mailing Address
First Line	:	4389 TERRABELLA WAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-3163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4988 PASEO PADRE PKWY # 204
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-3412
Country	:	US
Telephone Number	:	510-792-5551
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/17/2017

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