Provider Demographics
NPI:1235548066
Name:YU, KRISTEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:YU
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 1:11790 SW BARNES RD
Mailing Address - Street 2:BUILDING A SUITE 280
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5934
Mailing Address - Country:US
Mailing Address - Phone:503-626-9700
Mailing Address - Fax:
Practice Address - Street 1:11790 SW BARNES RD
Practice Address - Street 2:BUILDING A SUITE 280
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5934
Practice Address - Country:US
Practice Address - Phone:503-626-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0573911223P0221X
ORD105651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry