Provider Demographics
NPI:1568533297
Name:YU, MARY M (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:YU
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:MANLI
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4560 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 252
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:310-823-1328
Mailing Address - Fax:626-287-6738
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:SUITE 252
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:310-823-1328
Practice Address - Fax:626-287-6738
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 1325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist