Provider Demographics
NPI:1124134473
Name:YU, JOHN JUNG-SAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JUNG-SAN
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 1:351 HOSPITAL RD
Mailing Address - Street 2:#211
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-645-4000
Mailing Address - Fax:949-645-4042
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:#211
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-645-4000
Practice Address - Fax:949-645-4042
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30812207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308120Medicaid
CA00A308120Medicaid
CAA30812Medicare ID - Type Unspecified