Provider Demographics
NPI:1750538518
Name:YEUNG, PETRUS SHIU LUN (DMD)
Entity type:Individual
Prefix:DR
First Name:PETRUS
Middle Name:SHIU LUN
Last Name:YEUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PETRUS
Other - Middle Name:SHIU LUN
Other - Last Name:YEUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2528 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1434
Mailing Address - Country:US
Mailing Address - Phone:713-529-5656
Mailing Address - Fax:
Practice Address - Street 1:2528 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1434
Practice Address - Country:US
Practice Address - Phone:713-529-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2049649Medicaid