1639178981 NPI number — DR. CONRAD O YU MD

Table of content: DR. CONRAD O YU MD (NPI 1639178981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639178981 NPI number — DR. CONRAD O YU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YU
Provider First Name:
CONRAD
Provider Middle Name:
O
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:
1639178981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7455 W WASHINGTON AVE
Provider Second Line Business Mailing Address:
#160
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-878-0393
Provider Business Mailing Address Fax Number:
702-938-0135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7455 W WASHINGTON AVE
Provider Second Line Business Practice Location Address:
#160
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-878-0393
Provider Business Practice Location Address Fax Number:
702-938-0135
Provider Enumeration Date:
07/19/2005

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: 207XS0106X , with the licence number:  10895 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 10895 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100503155 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com