Provider Demographics
NPI:1528411055
Name:LI, YU (DMD)
Entity Type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 HERO WAY W STE A1
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1016
Mailing Address - Country:US
Mailing Address - Phone:512-522-8282
Mailing Address - Fax:
Practice Address - Street 1:12621 HERO WAY W STE A1
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1016
Practice Address - Country:US
Practice Address - Phone:512-522-8282
Practice Address - Fax:512-980-6907
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100495122300000X
TX360421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist