Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9383T | CA |
NPI | 1013001767 |
---|---|
Provider Name | Dr. Jae S Yu |
First Address | Torrance, CA 90501-2868 |
Second Address | Torrance, CA 90501-2868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 04/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013001767 | (05) | CA |