Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 101528 | CA |
NPI | 1003174467 |
---|---|
Provider Name | Xuan Yue |
First Address | Simi Valley, CA 93065-5031 |
Second Address | Beverly Hills, CA 90211-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 26/03/2020 |