Provider Demographics
NPI:1437184413
Name:YU, JOHN CN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CN
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 VALE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3849
Mailing Address - Country:US
Mailing Address - Phone:510-234-1194
Mailing Address - Fax:510-234-1196
Practice Address - Street 1:2089 VALE RD STE 20
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3849
Practice Address - Country:US
Practice Address - Phone:510-234-1194
Practice Address - Fax:510-234-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine