Provider Demographics
NPI:1811960875
Name:YU, LEISURE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LEISURE
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30688 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7619
Mailing Address - Country:US
Mailing Address - Phone:909-214-2105
Mailing Address - Fax:
Practice Address - Street 1:10459 MT VIEW AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2033
Practice Address - Country:US
Practice Address - Phone:909-799-3838
Practice Address - Fax:909-799-3830
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G623810Medicaid
CAP00143603OtherMEDICARE RAILROAD
CA1578756979OtherNPI TYPE II
CA602135600OtherUS DEPT. LABOR NUMBER
CA5498960001Medicare NSC
CAP00143603OtherMEDICARE RAILROAD
CA602135600OtherUS DEPT. LABOR NUMBER