Provider Demographics
NPI:1649203571
Name:YU, JOHN C L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C L
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10223 BROADWAY ST
Mailing Address - Street 2:SUITE P-226
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:281-886-4183
Mailing Address - Fax:713-436-3489
Practice Address - Street 1:1930 COUNTRY PLACE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2138
Practice Address - Country:US
Practice Address - Phone:281-506-7840
Practice Address - Fax:832-672-7485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7735207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF72214Medicare UPIN
311348Medicare PIN