Provider Demographics
NPI: | 1699914747 |
---|---|
Name: | DR.YU ACUPUNCTURE LLC |
Entity type: | Organization |
Organization Name: | DR.YU ACUPUNCTURE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHUI LIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | YU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DOM |
Authorized Official - Phone: | 505-720-6939 |
Mailing Address - Street 1: | 2612 SOUTHERN BLVD SE |
Mailing Address - Street 2: | SUITE A-1 |
Mailing Address - City: | RIO RANCHO |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87124-3759 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-896-2011 |
Mailing Address - Fax: | 505-896-7877 |
Practice Address - Street 1: | 2612 SOUTHERN BLVD SE |
Practice Address - Street 2: | SUITE A-1 |
Practice Address - City: | RIO RANCHO |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87124-3759 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-896-2011 |
Practice Address - Fax: | 505-896-7877 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-02-12 |
Last Update Date: | 2009-02-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | 672 | 302R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302R00000X | Managed Care Organizations | Health Maintenance Organization |