Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 278199 | MA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A170353 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 278199 | MA |
NPI | 1316176159 |
---|---|
Provider Name | Jason W Yu |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 30/04/2021 |