Provider Demographics
NPI:1972923357
Name:YU, DOVE M (LAC)
Entity Type:Individual
Prefix:
First Name:DOVE
Middle Name:M
Last Name:YU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 MANZANITA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4236
Mailing Address - Country:US
Mailing Address - Phone:650-451-2612
Mailing Address - Fax:
Practice Address - Street 1:1087 MANZANITA DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-4236
Practice Address - Country:US
Practice Address - Phone:650-451-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21856171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist