Provider Demographics
NPI:1932128618
Name:YUE, JIMMY
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:YUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S GARFIELD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-6815
Mailing Address - Country:US
Mailing Address - Phone:626-308-0133
Mailing Address - Fax:626-308-0683
Practice Address - Street 1:320 S GARFIELD AVE STE 206
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-6815
Practice Address - Country:US
Practice Address - Phone:626-308-0133
Practice Address - Fax:626-308-0683
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6758207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX67581Medicaid
CA20A6758AMedicare ID - Type UnspecifiedJIMMY YUE
CA00AX67581Medicaid