Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 104605 | CA |
NPI | 1003417627 |
---|---|
Provider Name | Dr. Timothy Yu |
First Address | Orange, CA 92867-1724 |
Second Address | Corona, CA 92882-5274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2020 |
Last Update Date | 02/11/2020 |