Provider Demographics
NPI:1932885811
Name:YU, IRENE I-FAN (DDS)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:I-FAN
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 1:188 W SAINT JAMES ST UNIT 10907
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2569
Mailing Address - Country:US
Mailing Address - Phone:408-896-2838
Mailing Address - Fax:
Practice Address - Street 1:1107 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2818
Practice Address - Country:US
Practice Address - Phone:831-603-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1106491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice