Provider Demographics
NPI:1710987672
Name:YU, SUJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJIN
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 METROPOLITAN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2407
Mailing Address - Country:US
Mailing Address - Phone:409-234-7088
Mailing Address - Fax:409-892-8237
Practice Address - Street 1:6025 METROPOLITAN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2407
Practice Address - Country:US
Practice Address - Phone:409-234-7088
Practice Address - Fax:409-892-8237
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA004OtherTRICARE/CHAMPUS
TX0020HDOtherGROUP BCBS
TX130025171OtherRAILROAD MEDICARE
TX148913001Medicaid
TX030255603Medicaid
TX4649893001OtherCIGNA
TX5194643OtherAETNA
TX8F3762OtherBCBS PROVIDER ID
TX8F3762OtherBCBS PROVIDER ID
TX0020HDOtherGROUP BCBS
TXG68382Medicare UPIN