Provider Demographics
NPI:1033155742
Name:YU, VINCENT TAKWING (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:TAKWING
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 PHAY AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2301
Mailing Address - Country:US
Mailing Address - Phone:719-285-2760
Mailing Address - Fax:719-285-2992
Practice Address - Street 1:1338 PHAY AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2311
Practice Address - Country:US
Practice Address - Phone:719-285-2760
Practice Address - Fax:719-285-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0030832207Q00000X
CO30832208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COYUA34484OtherBLUE CROSS
CO01308329Medicaid
CO01308329Medicaid