Provider Demographics
NPI:1750019048
Name:YU, BENEDICT (DPT)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:8665 TYRONE AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3117
Mailing Address - Country:US
Mailing Address - Phone:818-272-4504
Mailing Address - Fax:
Practice Address - Street 1:2001 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2932
Practice Address - Country:US
Practice Address - Phone:818-953-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist