Basic Information
| Provider Information | |||||||||
| NPI: | 1306011242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | YUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D./PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | YU | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 26522 LA ALAMEDA | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492821671 | ||||||||
| FaxNumber: | 9493670518 | ||||||||
| Practice Location | |||||||||
| Address1: | 26800 CROWN VALLEY PKWY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495428007 | ||||||||
| FaxNumber: | 9493643430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 237721 | MA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | A111852 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 00A1118520 | 05 | CA | MEDICAID |