Individual provider Active NPI

Seungyoun Lyu, DDS

  • Dentist
  • Hayward, CA
National Provider Identifier
1790170504
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DDS104870 Issued in CA
Practice address
22331 Mission Blvd
Hayward, CA 94541-3911
Phone
(510) 471-5880
NPI assigned
Mar 30, 2015
Last updated
Apr 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DDS104870 CA Primary
General Practice Dentistry 1223G0001X 319019913 IL

Addresses

Primary practice location

22331 Mission Blvd
Hayward, CA 94541-3911

Mailing address

22331 Mission Blvd
Hayward, CA 94541-3911
Phone (510) 471-5880

Other practice location 1

16110 E 14th St
Ashland, CA 94578-3002
Phone (510) 471-5880

Other practice location 2

28300 Huntwood Ave
Hayward, CA 94544-5425
Phone (510) 471-5880

Other practice location 3

33255 9th St
Union City, CA 94587-2137
Phone (510) 471-5880

Other practice location 4

680 W Tennyson Rd Rm 12
Hayward, CA 94544-5236
Phone (510) 471-5880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150806011556 OH Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8224342068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS104870CAMDDentist
319019913ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Illini Smiles Dental Care P.C. General Practice Past Accepting new patients
Tiburcio Vasquez Health Center, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1790170504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22331 MISSION BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413911",
            "telephone_number": "510-471-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22331 MISSION BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413911",
            "telephone_number": "510-471-5880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16110 E 14th St",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "CA",
            "postal_code": "945783002",
            "country_code": "US",
            "telephone_number": "510-471-5880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28300 Huntwood Ave",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "CA",
            "postal_code": "945445425",
            "country_code": "US",
            "telephone_number": "510-471-5880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "33255 9th St",
            "address_purpose": "LOCATION",
            "city": "Union City",
            "state": "CA",
            "postal_code": "945872137",
            "country_code": "US",
            "telephone_number": "510-471-5880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "680 W Tennyson Rd Rm 12",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "CA",
            "postal_code": "945445236",
            "country_code": "US",
            "telephone_number": "510-471-5880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYU",
        "first_name": "SEUNGYOUN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-30",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS104870",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "319019913",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, CA

Sources for this page

Verify at the official NPI Registry.