Provider Demographics
NPI:1164898409
Name:JOSEPH K YAU MD LLC
Entity Type:Organization
Organization Name:JOSEPH K YAU MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:YAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-201-4348
Mailing Address - Street 1:2215 E HIGH RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4860
Mailing Address - Country:US
Mailing Address - Phone:801-201-4348
Mailing Address - Fax:
Practice Address - Street 1:2215 E HIGH RIDGE LN
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4860
Practice Address - Country:US
Practice Address - Phone:801-201-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174377-1205261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT572735305062Medicaid
UT572735305062Medicaid