Provider Demographics
NPI:1780692830
Name:SU, GIGI YAKUAN (MD)
Entity type:Individual
Prefix:
First Name:GIGI
Middle Name:YAKUAN
Last Name:SU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX AD
Mailing Address - Street 2:PROVIDER CREDENTIALING
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-1396
Mailing Address - Country:US
Mailing Address - Phone:530-751-3769
Mailing Address - Fax:530-751-1237
Practice Address - Street 1:1000 SUTTER ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3459
Practice Address - Country:US
Practice Address - Phone:530-674-9420
Practice Address - Fax:530-674-9451
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A634270Medicaid
CAP00770145OtherRAILROAD MEDICARE
CAP00770145OtherRAILROAD MEDICARE
CA00A634270Medicaid
CABS8134758OtherDEA