Provider Demographics
NPI:1790147510
Name:YU, DIANA (DO)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16465 SIERRA LAKES PKWY STE 275
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1263
Mailing Address - Country:US
Mailing Address - Phone:909-823-8000
Mailing Address - Fax:909-823-8088
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 275
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336
Practice Address - Country:US
Practice Address - Phone:909-823-8000
Practice Address - Fax:909-823-8088
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17263208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics