Provider Demographics
NPI:1477713444
Name:CHIFOO DAVID YUE MD A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:CHIFOO DAVID YUE MD A PROFESSIONAL CORP.
Other - Org Name:AGAPE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIFOO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:YUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-484-8111
Mailing Address - Street 1:5309 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2235
Mailing Address - Country:US
Mailing Address - Phone:714-484-8111
Mailing Address - Fax:714-699-1410
Practice Address - Street 1:5309 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2235
Practice Address - Country:US
Practice Address - Phone:714-484-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68013207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16667Medicare PIN