Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 33469 | AZ |
NPI | 1023017381 |
---|---|
Provider Name | Bingfen Grace Yu |
First Address | Glendale, AZ 85306-4636 |
Second Address | Phoenix, AZ 85037-2384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
959314001 | (05) | AZ |