Provider Demographics
NPI:1508508656
Name:YUVAN LLC
Entity Type:Organization
Organization Name:YUVAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KOTESHWARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADIPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-666-4422
Mailing Address - Street 1:2812 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2838
Practice Address - Country:US
Practice Address - Phone:972-666-4422
Practice Address - Fax:972-688-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care