Provider Demographics
NPI:1487688842
Name:FURMAN, YURY (MD)
Entity Type:Individual
Prefix:
First Name:YURY
Middle Name:
Last Name:FURMAN
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 1:10532 ACACIA ST
Mailing Address - Street 2:B-4
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5446
Mailing Address - Country:US
Mailing Address - Phone:909-481-2577
Mailing Address - Fax:909-481-2546
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:STE 402
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-782-9894
Practice Address - Fax:323-782-0687
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14362AOtherMEDICARE
CA00G721621Medicaid
CAW14362BOtherGRP PTAN
CAW14362COtherGRP PTAN
CAWG72162EOtherIND PTAN
CAWG72162EOtherIND PTAN
CA00G721621Medicaid
CAW14362COtherGRP PTAN