Provider Demographics
NPI:1588619233
Name:YU, MELISSA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:BETH
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT LA 21555
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1555
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:1 HOAG DRIVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-764-5770
Practice Address - Fax:949-263-1639
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA717532085N0700X, 2085R0202X
CO448032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A717530Medicaid
CA00A717530OtherBS
COP00353268OtherRR RIA MEDICARE
CO44803OtherCO LICENSE
CO62654811Medicaid
COC805710Medicare PIN
CO44803OtherCO LICENSE
CA00A717530OtherBS
I00645Medicare UPIN
COC805712Medicare PIN