Basic Information
| Provider Information | |||||||||
| NPI: | 1275074627 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YU | ||||||||
| FirstName: | WEN YUAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6355 S BUFFALO DR FL 3 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891132133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 5230 BOULDER HWY STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891226077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029401560 | ||||||||
| FaxNumber: | 7029401561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2017 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | DO2777 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DO2777 | 01 | NV | LICENSE | OTHER | 1275074627 | 05 | NV | MEDICAID |