Provider Demographics
NPI:1497148126
Name:YU, SAMUEL CHEOL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CHEOL
Last Name:YU
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6268 S RAINBOW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3241
Mailing Address - Country:US
Mailing Address - Phone:702-292-9729
Mailing Address - Fax:702-505-9235
Practice Address - Street 1:6268 S RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3241
Practice Address - Country:US
Practice Address - Phone:702-292-9729
Practice Address - Fax:702-505-9235
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95001562363LF0000X
NVAPRN002598363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497148126Medicaid