Provider Demographics
NPI:1710242847
Name:YU, STACY L (DDS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
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 1:1435 S BUNDY DR
Mailing Address - Street 2:APT 5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2131
Mailing Address - Country:US
Mailing Address - Phone:714-496-5364
Mailing Address - Fax:
Practice Address - Street 1:1435 S BUNDY DR
Practice Address - Street 2:APT 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2131
Practice Address - Country:US
Practice Address - Phone:714-496-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics