Provider Demographics
NPI:1265499685
Name:YU, AUSTIN T (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:T
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10105 BANBURRY CROSS DRIVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-260-2545
Mailing Address - Fax:702-869-0133
Practice Address - Street 1:10105 BANBURRY CROSS DRIVE
Practice Address - Street 2:SUITE 370
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-260-2545
Practice Address - Fax:702-869-0133
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV20858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG18648OtherHEALTH ALLIANCE PLANS
MI001012OtherMIDWEST HEALTH PLANS
MI350H210660OtherBCBSM/BCN
MI50317OtherOMNICARE HEALTH PLANS
MI3199450Medicaid
MI41604OtherOMNICARE HEALTH PLANS
MI149304OtherGREAT LAKES HEALTH PLANS
MI020691OtherMIDWEST HEALTH PLANS
MI108884OtherGREAT LAKES HEALTH PLANS
MI350Q260790OtherBCBSM/BCN
MI4164960Medicaid
MI350Q260790OtherBCBSM/BCN
MI0Q26079004Medicare ID - Type Unspecified
MI020691OtherMIDWEST HEALTH PLANS