Provider Demographics
NPI:1013001767
Name:YU, JAE S (OD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:S
Last Name:YU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1261 CABRILLO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2868
Mailing Address - Country:US
Mailing Address - Phone:310-618-2244
Mailing Address - Fax:310-618-2240
Practice Address - Street 1:1261 CABRILLO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2868
Practice Address - Country:US
Practice Address - Phone:310-618-2244
Practice Address - Fax:310-618-2240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9383T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013001767Medicaid
CA1013001767Medicaid