Provider Demographics
NPI:1225181456
Name:YURKOV, DREW
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:YURKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N SAN MATEO DR
Mailing Address - Street 2:101
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2777
Mailing Address - Country:US
Mailing Address - Phone:650-558-5303
Mailing Address - Fax:
Practice Address - Street 1:136 N SAN MATEO DR
Practice Address - Street 2:101
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2777
Practice Address - Country:US
Practice Address - Phone:650-558-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XOtherMENTAL HEALTH