Provider Demographics
NPI:1982603304
Name:YU, QUNTAO (MD)
Entity Type:Individual
Prefix:
First Name:QUNTAO
Middle Name:
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 1:4427 HIGHWAY 6
Mailing Address - Street 2:SUITE J
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4424
Mailing Address - Country:US
Mailing Address - Phone:281-565-8188
Mailing Address - Fax:
Practice Address - Street 1:4427 HIGHWAY 6
Practice Address - Street 2:SUITE J
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4424
Practice Address - Country:US
Practice Address - Phone:281-565-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0720208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092450801Medicaid
TX092450801Medicaid