Provider Demographics
NPI:1346212354
Name:YU, DAVID DEOK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEOK
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:#340
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3023
Mailing Address - Country:US
Mailing Address - Phone:626-796-5325
Mailing Address - Fax:626-796-5526
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:#340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3023
Practice Address - Country:US
Practice Address - Phone:626-796-5325
Practice Address - Fax:626-796-5526
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71597207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79446ZMedicaid
CA00G715970Medicaid
CA1904740001Medicare NSC
CAF26168Medicare UPIN
CAW2157Medicare PIN
WG71597AMedicare PIN