Basic Information
| Provider Information | |||||||||
| NPI: | 1538693940 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YU | ||||||||
| FirstName: | ANDRE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 SANTA MONICA BLVD STE 304 | ||||||||
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| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298868 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1821 WILSHIRE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904035627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298975 | ||||||||
| FaxNumber: | 4242914108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0002X | A173055 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.