Provider Demographics
NPI:1851823082
Name:YU, BO
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 LEVERING AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2761
Mailing Address - Country:US
Mailing Address - Phone:510-735-4553
Mailing Address - Fax:
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:STE 350
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6970
Practice Address - Country:US
Practice Address - Phone:310-794-5750
Practice Address - Fax:310-208-0786
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist