Healthcare Provider Details

I. General information

NPI: 1043377286
Provider Name (Legal Business Name): SAMUEL YIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SAN PABLO ST SUITE 4000
LOS ANGELES CA
90033-4668
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-6335
  • Fax: 323-442-7166
Mailing address:
  • Phone:
  • Fax: 323-442-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA68541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD73528
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: