Provider Demographics
NPI:1548228034
Name:OKUIZUMI WU, YURI (MD)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:
Last Name:OKUIZUMI WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YURI
Other - Middle Name:
Other - Last Name:OKUSZUMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:798 VEDADO WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-815-0967
Mailing Address - Fax:
Practice Address - Street 1:35 WHITEFOORD AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317
Practice Address - Country:US
Practice Address - Phone:404-588-0101
Practice Address - Fax:404-588-0226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28795Medicare UPIN