Provider Demographics
NPI:1679984215
Name:YU, STANLEY RAYMOND (MD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:RAYMOND
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 1:7101 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3862
Mailing Address - Country:US
Mailing Address - Phone:951-682-9780
Mailing Address - Fax:909-682-9787
Practice Address - Street 1:7101 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3862
Practice Address - Country:US
Practice Address - Phone:951-682-9780
Practice Address - Fax:909-682-9787
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA142049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598882078Medicaid