MEDICARE: DR. SAMUEL CHEOL YU NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95001562	CA
2	363LP2300X	Primary Care Nurse Practitioner	APRN002598	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497148126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL CHEOL YU NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6268 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3241
Country	:	US
Telephone Number	:	702-292-9729
Fax Number	:	702-505-9235

Provider Business Practice Location Address
First Line	:	6268 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3241
Country	:	US
Telephone Number	:	702-292-9729
Fax Number	:	702-505-9235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	10/19/2020

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