Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G55744 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | G55744 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | G55744 | CA |
N | 207R00000X | Internist | G55744 | CA |
N | 111NI0900X | Internist | G55744 | CA |
NPI | 1265485684 |
---|---|
Provider Name | Dr. Jack N Yu |
First Address | Emeryville, CA 94608-1826 |
Second Address | Glendale, CA 91206-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G557440 | (05) | CA |
E93825 | (02) | CA |