Provider Demographics
NPI:1114230570
Name:JIA, YOU (DDS)
Entity Type:Individual
Prefix:
First Name:YOU
Middle Name:
Last Name:JIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PENFIELD ROAD
Mailing Address - Street 2:PENFIELD
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526
Mailing Address - Country:US
Mailing Address - Phone:585-275-5051
Mailing Address - Fax:
Practice Address - Street 1:2100 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1736
Practice Address - Country:US
Practice Address - Phone:585-364-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist