Provider Demographics
NPI:1932135043
Name:SU, YU TANG JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:YU TANG
Middle Name:JAMES
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2103 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3489
Mailing Address - Country:US
Mailing Address - Phone:956-271-4719
Mailing Address - Fax:956-271-4717
Practice Address - Street 1:2103 E GRIFFIN PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3489
Practice Address - Country:US
Practice Address - Phone:956-271-4719
Practice Address - Fax:956-271-4717
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6751174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127740000Medicaid
ME8408B6Medicare PIN