Provider Demographics
NPI:1235120932
Name:YU, CHANGPAE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANGPAE
Middle Name:J
Last Name:YU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 JERICHO TPKE
Mailing Address - Street 2:STE 218
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2909
Mailing Address - Country:US
Mailing Address - Phone:631-462-1111
Mailing Address - Fax:631-858-1191
Practice Address - Street 1:6500 JERICHO TPKE
Practice Address - Street 2:STE 218
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2909
Practice Address - Country:US
Practice Address - Phone:631-462-1111
Practice Address - Fax:631-858-1191
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist