Provider Demographics
NPI:1124274030
Name:YU, CHERYL CHIA MIN (OD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:CHIA MIN
Last Name:YU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 S HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4243
Mailing Address - Country:US
Mailing Address - Phone:626-330-4115
Mailing Address - Fax:626-330-4116
Practice Address - Street 1:2115 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4243
Practice Address - Country:US
Practice Address - Phone:626-330-4115
Practice Address - Fax:626-330-4116
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13475152W00000X
HIOD 690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FI811ZOtherMEDICARE PTAN