Provider Demographics
NPI:1437372521
Name:YU, KAN (MD,PHD)
Entity Type:Individual
Prefix:
First Name:KAN
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S LINDSAY RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2100
Mailing Address - Country:US
Mailing Address - Phone:480-899-2212
Mailing Address - Fax:480-899-2022
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:SUITE 118
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2100
Practice Address - Country:US
Practice Address - Phone:480-899-2212
Practice Address - Fax:480-899-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ364982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201809Medicaid
AZZ115635Medicare PIN
AZ201809Medicaid
201809Medicare PIN