Provider Demographics
NPI:1255317483
Name:YU, KENNETH CY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CY
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 1:19288 STONE OAK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3222
Mailing Address - Country:US
Mailing Address - Phone:866-574-1719
Mailing Address - Fax:
Practice Address - Street 1:21727 IH 10 W STE 218
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-2107
Practice Address - Country:US
Practice Address - Phone:210-876-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE65816207Y00000X
TXP25632082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology