Provider Demographics
NPI:1619175700
Name:YU, JEFFERSON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:C
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 VILLAGE CENTER CIRCLE
Mailing Address - Street 2:STE 3-132
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134
Mailing Address - Country:US
Mailing Address - Phone:702-582-9440
Mailing Address - Fax:702-965-4581
Practice Address - Street 1:1930 VILLAGE CENTER CIRCLE
Practice Address - Street 2:STE 3-132
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134
Practice Address - Country:US
Practice Address - Phone:702-582-9440
Practice Address - Fax:702-965-4581
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13594208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500484 MEDICAIDMedicaid
NVVWQBHV GROUPMedicare PIN