Provider Demographics
NPI:1215551106
Name:YU, FENGYUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FENGYUAN
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 162ND ST # 3F
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17457 CAFFEE RD STE 204
Practice Address - Street 2:
Practice Address - City:DAHLGREN
Practice Address - State:VA
Practice Address - Zip Code:22448-5120
Practice Address - Country:US
Practice Address - Phone:540-653-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2023-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11797305-9921122300000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No122300000XDental ProvidersDentist