Provider Demographics
NPI:1073791513
Name:BENSON W. YU M.D. PLLC
Entity Type:Organization
Organization Name:BENSON W. YU M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:W
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-691-1136
Mailing Address - Street 1:3601 CHAIN BRIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3243
Mailing Address - Country:US
Mailing Address - Phone:703-691-1136
Mailing Address - Fax:703-691-8116
Practice Address - Street 1:3601 CHAIN BRIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3243
Practice Address - Country:US
Practice Address - Phone:703-691-1136
Practice Address - Fax:703-691-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005835984Medicaid
F43098Medicare UPIN
VA005835984Medicaid