Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN1855593 | MA |
N | 1223P0300X | Periodontist | 10398 | MA |
NPI | 1093966673 |
---|---|
Provider Name | Dr. Leon C Yu |
First Address | Boston, MA 02118-3261 |
Second Address | Boston, MA 02118-3261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 28/04/2014 |