Provider Demographics
NPI:1336432392
Name:YU, SANG C (DMD)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:C
Last Name:YU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E DESERT INN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2550
Mailing Address - Country:US
Mailing Address - Phone:702-862-8550
Mailing Address - Fax:702-892-8431
Practice Address - Street 1:1500 E DESERT INN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2550
Practice Address - Country:US
Practice Address - Phone:702-862-8550
Practice Address - Fax:702-892-8431
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist