Provider Demographics
NPI:1609865781
Name:YU, SHUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHUAN
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 1:14020 SANFORD AVE 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2562
Mailing Address - Country:US
Mailing Address - Phone:718-353-0960
Mailing Address - Fax:718-353-7646
Practice Address - Street 1:60 JAYSON AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4238
Practice Address - Country:US
Practice Address - Phone:718-844-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist