Provider Demographics
NPI:1285799361
Name:YU, LISA (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 ARNOLD WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5748
Mailing Address - Country:US
Mailing Address - Phone:714-904-4388
Mailing Address - Fax:714-525-5443
Practice Address - Street 1:2095 ARNOLD WAY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-5748
Practice Address - Country:US
Practice Address - Phone:714-904-4388
Practice Address - Fax:714-525-5443
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-0114-061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry