Provider Demographics
NPI:1578756979
Name:LEISURE YU, MD, INC.
Entity Type:Organization
Organization Name:LEISURE YU, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:LEISURE
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-214-2105
Mailing Address - Street 1:30688 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7619
Mailing Address - Country:US
Mailing Address - Phone:909-214-2105
Mailing Address - Fax:
Practice Address - Street 1:10459 MT VIEW AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2033
Practice Address - Country:US
Practice Address - Phone:909-799-3838
Practice Address - Fax:909-799-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62381207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
602135600OtherUS DEPT OF LABOR
CA00G623810Medicaid
CA5498960001Medicare NSC
602135600OtherUS DEPT OF LABOR
G623811Medicare PIN