Provider Demographics
NPI:1780612556
Name:YU, SCOTT CHUNGYU (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHUNGYU
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 1:9130 NOLAN ST
Mailing Address - Street 2:APT 1012
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7501
Mailing Address - Country:US
Mailing Address - Phone:913-206-9191
Mailing Address - Fax:
Practice Address - Street 1:2100 POWELL STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1803
Practice Address - Country:US
Practice Address - Phone:510-350-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102410207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1024101Medicare PIN
CA0A1024100Medicare PIN