Provider Demographics
NPI:1700908944
Name:MAO, YOUQUN (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:YOUQUN
Middle Name:
Last Name:MAO
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:YOU-QUN
Other - Last Name:MAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDD, PHD
Mailing Address - Street 1:22393 MCCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2768
Mailing Address - Country:US
Mailing Address - Phone:408-252-9822
Mailing Address - Fax:408-252-1856
Practice Address - Street 1:226 BARBER CT
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7915
Practice Address - Country:US
Practice Address - Phone:408-955-9898
Practice Address - Fax:408-955-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice