Provider Demographics
NPI:1679794440
Name:HE, HARRY YU (DDS)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:YU
Last Name:HE
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 1:4040 PRESIDENTIAL BLVD
Mailing Address - Street 2:1909
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1727
Mailing Address - Country:US
Mailing Address - Phone:626-272-2883
Mailing Address - Fax:
Practice Address - Street 1:10108 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3704
Practice Address - Country:US
Practice Address - Phone:626-272-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507541223G0001X
PADS0381991223G0001X
DEG1-00013111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice