Provider Demographics
NPI:1083832661
Name:PU, YONGBING LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:YONGBING
Middle Name:LARRY
Last Name:PU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YONGBING
Other - Middle Name:L
Other - Last Name:PU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:260 GRAYSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4345
Mailing Address - Country:US
Mailing Address - Phone:757-497-3670
Mailing Address - Fax:757-499-1947
Practice Address - Street 1:260 GRAYSON RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4345
Practice Address - Country:US
Practice Address - Phone:757-497-3670
Practice Address - Fax:757-499-1947
Is Sole Proprietor?:No
Enumeration Date:2007-04-21
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4417322084P0800X, 2084P0800X
VA01012539962084P0800X
NJ25MA089109002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA108382661Medicaid