Basic Information
| Provider Information | |||||||||
| NPI: | 1053546671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YUKIO | ||||||||
| FirstName: | UYLY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1045 CENTRAL PKWY N | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105369591 | ||||||||
| FaxNumber: | 9044252949 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 NAVARRO ST | ||||||||
| Address2: | SUITE #809 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102254810 | ||||||||
| FaxNumber: | 8553927989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R0678 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | R0678 | 01 | TX | TX MEDICAL LICENSE | OTHER |