Provider Demographics
NPI:1548750896
Name:YU, JUSTIN MORTON
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MORTON
Last Name:YU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 LOMITA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1902
Mailing Address - Country:US
Mailing Address - Phone:424-378-1323
Mailing Address - Fax:
Practice Address - Street 1:1852 LOMITA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1902
Practice Address - Country:US
Practice Address - Phone:424-378-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist