Provider Demographics
NPI:1780766931
Name:WANG, YU (MD)
Entity type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 NE 85TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3539
Mailing Address - Country:US
Mailing Address - Phone:425-698-7436
Mailing Address - Fax:425-526-7288
Practice Address - Street 1:16150 NE 85TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3539
Practice Address - Country:US
Practice Address - Phone:425-698-7436
Practice Address - Fax:425-526-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5070207P00000X, 207Q00000X
WAMD00048868207Q00000X
IA36919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00455204OtherMEDICARE RAILROAD
IA36919OtherIA MEDICAL LICENSE
8498495OtherMEDICAL ASST ID (MEDICAID
WAMD00048868OtherWA MEDICAL LICENSE
NE5070OtherSTATE MEDICAL LICENSE
8498495OtherMEDICAL ASST ID (MEDICAID
WAMD00048868OtherWA MEDICAL LICENSE