Provider Demographics
NPI:1881897452
Name:YU, CHEOL H
Entity type:Individual
Prefix:DR
First Name:CHEOL
Middle Name:H
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 1:910 S GRAMERCY PL
Mailing Address - Street 2:APT #106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2178
Mailing Address - Country:US
Mailing Address - Phone:714-480-3000
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:210 N 11TH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4590
Practice Address - Country:US
Practice Address - Phone:559-585-2170
Practice Address - Fax:559-585-2178
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55717Medicaid