Provider Demographics
NPI:1902650252
Name:YU, CHERNGDER (DC)
Entity Type:Individual
Prefix:
First Name:CHERNGDER
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15528 KENNARD ST
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3401
Mailing Address - Country:US
Mailing Address - Phone:626-383-9816
Mailing Address - Fax:
Practice Address - Street 1:15528 KENNARD ST
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3401
Practice Address - Country:US
Practice Address - Phone:626-383-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor