Basic Information
| Provider Information | |||||||||
| NPI: | 1275641474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | KEUN | ||||||||
| MiddleName: | YUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YU | ||||||||
| OtherFirstName: | KEN | ||||||||
| OtherMiddleName: | KEUNYUNG | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 STATE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471504990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 05/12/2016 | ||||||||
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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 | 207L00000X | 20496 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 01035577A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101037318 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 100116230A | 01 | IN | MEDICAID | OTHER | M400075712 | 01 | IN | MEDICARE PTAN | OTHER | P01081491 | 01 | IN | MEDICARE RR PTAN | OTHER |