Provider Demographics
NPI:1326363524
Name:YU, TIFFANY FU (MA, OTR/L, SWC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FU
Last Name:YU
Suffix:
Gender:F
Credentials:MA, OTR/L, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5013
Mailing Address - Country:US
Mailing Address - Phone:310-337-7115
Mailing Address - Fax:310-216-6153
Practice Address - Street 1:6315 ARIZONA PL
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1252
Practice Address - Country:US
Practice Address - Phone:310-337-7115
Practice Address - Fax:310-216-6153
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist