Provider Demographics
NPI:1629019112
Name:JU, BEN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:Y
Last Name:JU
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:HC 3 BOX 9888
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9513
Mailing Address - Country:US
Mailing Address - Phone:787-209-3162
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 9888
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-9513
Practice Address - Country:US
Practice Address - Phone:787-209-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15142208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI50645Medicare UPIN
PR0023352Medicare ID - Type Unspecified