Healthcare Provider Details

I. General information

NPI: 1629007463
Provider Name (Legal Business Name): REGULLANO AND YU MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W BEVERLY BLVD STE 202
MONTEBELLO CA
90640-3951
US

IV. Provider business mailing address

2101 W BEVERLY BLVD STE 202
MONTEBELLO CA
90640-3951
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-4674
  • Fax: 323-722-9238
Mailing address:
  • Phone: 323-722-4674
  • Fax: 323-722-9238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN TAN YU
Title or Position: PARTNER
Credential: M.D.
Phone: 323-722-4674