Provider Demographics
NPI:1972650257
Name:YU, ALLEN HB (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:HB
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-572-2844
Mailing Address - Fax:253-572-2841
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-572-2844
Practice Address - Fax:253-572-2841
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0430430OtherL&I
WA1096312Medicaid
WA0430430OtherL&I