Provider Demographics
NPI:1861827537
Name:YU, JENNY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13690 E 14TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2582
Mailing Address - Country:US
Mailing Address - Phone:510-614-5633
Mailing Address - Fax:510-614-2286
Practice Address - Street 1:13690 E 14TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2582
Practice Address - Country:US
Practice Address - Phone:510-614-5633
Practice Address - Fax:510-614-2286
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5086213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5086OtherPODIATRY LICENSE