Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 20300 | TX |
NPI | 1114048105 |
---|---|
Provider Name | David Yu |
First Address | West Lake Hills, TX 78746-6465 |
Second Address | West Lake Hills, TX 78746-6465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |