Provider Demographics
NPI:1275641474
Name:YU, KEUN YUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KEUN
Middle Name:YUNG
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:KEUNYUNG
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:320 WHITTINGTON PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4928
Mailing Address - Country:US
Mailing Address - Phone:502-625-5584
Mailing Address - Fax:502-426-2264
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:502-625-5584
Practice Address - Fax:502-426-2264
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20496207L00000X
IN01035577A207L00000X
VA0101037318207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100116230AOtherMEDICAID
INM400075712OtherMEDICARE PTAN
INP01081491OtherMEDICARE RR PTAN