Provider Demographics
NPI:1326001991
Name:YU, YONG MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:MAX
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 60 MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-886-6995
Mailing Address - Fax:718-886-8603
Practice Address - Street 1:41 60 MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-886-6995
Practice Address - Fax:718-886-8603
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01825465Medicaid
NY01825465Medicaid
NYG61065Medicare UPIN