Provider Demographics
NPI:1760484240
Name:JUE, DYRON J (MD)
Entity Type:Individual
Prefix:DR
First Name:DYRON
Middle Name:J
Last Name:JUE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 FOREST AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1448
Mailing Address - Country:US
Mailing Address - Phone:408-280-0755
Mailing Address - Fax:408-280-0652
Practice Address - Street 1:2101 FOREST AVE
Practice Address - Street 2:STE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1448
Practice Address - Country:US
Practice Address - Phone:408-280-0755
Practice Address - Fax:408-280-0652
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74895207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A748950Medicaid
CAI29741Medicare UPIN
00A748950Medicare ID - Type Unspecified