Provider Demographics
NPI:1497938286
Name:INJUN YU, YOUNGOCK YU
Entity Type:Organization
Organization Name:INJUN YU, YOUNGOCK YU
Other - Org Name:SONG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOUNGOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-248-7842
Mailing Address - Street 1:1090 KIELY BLVD.
Mailing Address - Street 2:A
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-248-7842
Mailing Address - Fax:408-248-1365
Practice Address - Street 1:1090 KIELY BLVD.
Practice Address - Street 2:A
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-248-7842
Practice Address - Fax:408-248-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA420330Medicare PIN