Provider Demographics
NPI:1780390732
Name:YU, SPENCER ERWIN
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:ERWIN
Last Name:YU
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 1:1340 N FREEDOM BLVD APT 117
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5673
Mailing Address - Country:US
Mailing Address - Phone:314-740-3276
Mailing Address - Fax:
Practice Address - Street 1:1340 N FREEDOM BLVD APT 117
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5673
Practice Address - Country:US
Practice Address - Phone:314-740-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program