Provider Demographics
NPI:1326554650
Name:WANG, YU (DDS, MDS, MS, DMD)
Entity type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS, MDS, MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 71ST RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4977
Mailing Address - Country:US
Mailing Address - Phone:718-544-8787
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD STE 120
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4977
Practice Address - Country:US
Practice Address - Phone:718-544-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614901223P0300X, 1223P0300X
PARFD0000231223P0300X
VA04014157531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics