Provider Demographics
NPI:1689199770
Name:LYU, YOUNGSU (DC)
Entity Type:Individual
Prefix:DR
First Name:YOUNGSU
Middle Name:
Last Name:LYU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 MOORPARK AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1804
Mailing Address - Country:US
Mailing Address - Phone:408-601-0703
Mailing Address - Fax:
Practice Address - Street 1:4010 MOORPARK AVE STE 116
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1804
Practice Address - Country:US
Practice Address - Phone:408-601-0703
Practice Address - Fax:408-618-6162
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor