Provider Demographics
NPI:1194871475
Name:DR YU'S FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:DR YU'S FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYI
Authorized Official - Middle Name:WIN
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-945-6500
Mailing Address - Street 1:8704A ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1610
Mailing Address - Country:US
Mailing Address - Phone:718-945-6500
Mailing Address - Fax:718-945-6509
Practice Address - Street 1:8704A ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1610
Practice Address - Country:US
Practice Address - Phone:718-945-6500
Practice Address - Fax:718-945-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0026VDOtherMEDICARE - EMPIRE
NY01749682Medicaid
NY01749682Medicaid
NY07730GMedicare PIN
NY0026VDOtherMEDICARE - EMPIRE