Provider Demographics
NPI:1962575506
Name:YU, SIMON GIN HAO (DC)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:GIN HAO
Last Name:YU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 JENEVEIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066
Mailing Address - Country:US
Mailing Address - Phone:650-877-0999
Mailing Address - Fax:650-877-0960
Practice Address - Street 1:654 JENEVEIN AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-877-0999
Practice Address - Fax:650-877-0960
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0270010Medicare UPIN