Provider Demographics
NPI:1447816814
Name:YU, PHIL KAM TUNG (DMD)
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:KAM TUNG
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 1:190 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6092
Mailing Address - Country:US
Mailing Address - Phone:510-213-8793
Mailing Address - Fax:
Practice Address - Street 1:6111 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5714
Practice Address - Country:US
Practice Address - Phone:517-393-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist