Provider Demographics
NPI:1679697031
Name:LYOU, MARSHALL YOUNG (MARSHALL LYOU, DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:YOUNG
Last Name:LYOU
Suffix:
Gender:M
Credentials:MARSHALL LYOU, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17777 CRENSHAW BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504
Mailing Address - Country:US
Mailing Address - Phone:310-323-9253
Mailing Address - Fax:
Practice Address - Street 1:17777 CRENSHAW BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504
Practice Address - Country:US
Practice Address - Phone:310-323-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0325791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice