Provider Demographics
NPI:1497317234
Name:YI, EDDIE YU-KUANG (DDS)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:YU-KUANG
Last Name:YI
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 1:9538 FALL PASS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4357
Mailing Address - Country:US
Mailing Address - Phone:214-693-7654
Mailing Address - Fax:
Practice Address - Street 1:6531 FM 78
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1454
Practice Address - Country:US
Practice Address - Phone:210-661-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN151461223G0001X
TX35294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice