Provider Demographics
NPI:1326068255
Name:ANTONIO V. YU JR., M.D.,P.C.
Entity Type:Organization
Organization Name:ANTONIO V. YU JR., M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:V
Authorized Official - Last Name:YU
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:623-556-2252
Mailing Address - Street 1:13945 W GRAND AVE
Mailing Address - Street 2:SUITE A 102
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2437
Mailing Address - Country:US
Mailing Address - Phone:623-556-2252
Mailing Address - Fax:623-556-2262
Practice Address - Street 1:13945 W GRAND AVE
Practice Address - Street 2:SUITE A 102
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2437
Practice Address - Country:US
Practice Address - Phone:623-556-2252
Practice Address - Fax:623-556-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1770564171OtherNPI
AZ594805Medicaid
AZF60571Medicare UPIN
AZ1770564171OtherNPI
AZ594805Medicaid