Provider Demographics
NPI:1073621629
Name:SHELLY YU DDS INC
Entity Type:Organization
Organization Name:SHELLY YU DDS INC
Other - Org Name:LAKEVIEW DENTAL OFFICE.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:XIAO YUE
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-345-6888
Mailing Address - Street 1:2571 CALIFORNIA PARK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4042
Mailing Address - Country:US
Mailing Address - Phone:530-345-6888
Mailing Address - Fax:530-345-9988
Practice Address - Street 1:2571 CALIFORNIA PARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4042
Practice Address - Country:US
Practice Address - Phone:530-345-6888
Practice Address - Fax:530-345-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty