1639156649 NPI number — DR. JOSEPH K YAU MD

Table of content: DR. JOSEPH K YAU MD (NPI 1639156649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639156649 NPI number — DR. JOSEPH K YAU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAU
Provider First Name:
JOSEPH
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639156649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 HIGH RIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84092-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-201-4348
Provider Business Mailing Address Fax Number:
801-619-9796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5667 S REDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84123-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-918-3220
Provider Business Practice Location Address Fax Number:
801-905-1161
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  174377-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 174377-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 94298348YAU . This is a "EDUCATORS MUTUAL INS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: E27833 . This is a "MEDICARE HMO" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 876000545838 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55296 . This is a "DESERET MUTUAL INS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1639156649 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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